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WALGREEN EASTERN CO., INC.
CAH471303-00 NORTHEASTERN VERMONT REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
NORTHEASTERN VERMONT REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471303-00
Entity Address
1315 HOSPITAL DRIVE
ST JOHNSBURY, VT 05819
Medicare Provider Number
471303
Participating Start Date
9/28/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #17625
412 BROAD ST
LYNDONVILLE, VT 05851
Pharmacy Comments
Contract Details
Approval Date
2/12/2018
Contract Begin Date
2/12/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Hersey, CFO
(802) 748-7530
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/12/2018
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