Contract Pharmacy Details

WAL-MART PHARMACY 10-2682
CHC26798-06 Gifford Health Care, Inc.

Covered Entity Details

Entity Name

Gifford Health Care, Inc.

Subdivision Name

Twin River Health Center

Type

HRSA-Funded Health Center

340B ID

CHC26798-06

Entity Address

108 N Main St
White River Junction, VT 05001-7056

Grant Number

H80CS26798

Participating Start Date

7/1/2014

Last Recertification Date

2/3/2020

Entity Termination Date

7/1/2020

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

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

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

5/13/2014

340B Drug Pricing Program Database