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WALGREEN EASTERN CO., INC.
CAH471307-00 Porter Hospital
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Covered Entity Details
Entity Name
Porter Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471307-00
Entity Address
115 PORTER DRIVE
MIDDLEBURY, VT 05753
Medicare Provider Number
471307
Participating Start Date
9/27/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #18375
263 COURT ST
MIDDLEBURY, VT 05753
Pharmacy Comments
Contract Details
Approval Date
2/15/2018
Contract Begin Date
2/16/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Beinhaur, CNO
(802) 388-5637
Contract Pharmacy Representative
Porter Medical Center
Renee Mosier, Pharmacy Director
(802) 388-4701 Ext: 5624
Signed By Date
2/15/2018
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