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RITE AID OF VERMONT, INC.
RRC470012-00 SOUTHWESTERN VERMONT MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHWESTERN VERMONT MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC470012-00
Entity Address
100 HOSPITAL DR
BENNINGTON, VT 05201
Medicare Provider Number
470012
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
RITE AID OF VERMONT, INC.
Pharmacy Address
RITE AID #1363
4993 MAIN STREET SUITE A
MANCHESTER CENTER, VT 05255
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2018
Ownership change
Contacts
Covered Entity Signing Official
Stephen D. Majetich, CFO
(802) 447-5011
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/15/2015
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