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MAXI GREEN, INC.
CH01397H RICHFORD HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
RICHFORD HEALTH CENTER, INC.
Subdivision Name
Fairfield Street Health Center
Type
HRSA-Funded Health Center
340B ID
CH01397H
Entity Address
77 Fairfield Street
Saint Albans, VT 05478-1716
Grant Number
H80CS00261
Participating Start Date
4/1/2016
Last Recertification Date
1/30/2019
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
MAXI GREEN, INC.
Pharmacy Address
RITE AID #10322
221 MAIN STREET
PO BOX 308
ENOSBURG FALLS, VT 05450
Pharmacy Comments
Contract Details
Approval Date
2/10/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Rite Aid Corp.
Wendy Barnes, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
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