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WAL-MART PHARMACY 10-2682
CHC26798-02 Gifford Health Care, Inc.
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Covered Entity Details
Entity Name
Gifford Health Care, Inc.
Subdivision Name
Bethel Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26798-02
Entity Address
1823 Vt Rte 107 Uppr Level
Bethel, VT 05032-9107
Grant Number
H80CS26798
Participating Start Date
7/1/2014
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2682
Pharmacy Address
282 BERLIN MALL ROAD UNIT #1
BERLIN, VT 05602
Pharmacy Comments
Contract Details
Approval Date
5/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Hebert, CFO
(802) 728-2356
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
5/12/2014
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