Covered Entity Details

DSH470003CA UNIVERSITY OF VERMONT MEDICAL CENTER (Active) - information as of 6/21/2025 12:02:35 AM

Main Details

Name

UNIVERSITY OF VERMONT MEDICAL CENTER

Subdivision Name

Dermatology - Tilley Drive

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH470003CA

Medicare Provider Number

470003

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/9/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/21/2024

Last Recertification Date

Contacts

Authorizing Official

University of Vermont Medical Center, Inc
Wesley McMillian, Network Vice President of Pharmacy
(802) 847-3546

Primary Contact

UNIVERSITY OF VERMONT MEDICAL CENTER
Minela Beric, Manager, Network 340B & Pharmacy Ops
(802) 542-3455

Addresses

Street Address

350 Tilley Drive
Suite 201
South Burlington, VT 05403

Billing Address

UNIVERSITY OF VERMONT MEDICAL CENTER
PO Box 1870
111 Colchester Avenue
Burlington, VT 05402

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
VT	0VN0997,470003	1568419976,1659309615

Shipping Addresses

Shipping Address 1

University of Vermont Medical Center
Main Campus
111 Colchester Avenue
Burlington, VT 05401

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH470003AA	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Bariatric Surgery - Williston	353 Blair Park Road	Williston	VT	Active
DSH470003AB	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Plastic, Reconstructive and Cosmetic Surgery	354 Mountain View Drive	Colchester	VT	Active
DSH470003AC	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Transplant Surgery	1 South Prospect Street	Burlington	VT	Active
DSH470003AE	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Pelvic Medicine and Reconstructive Surgery	792 College Parkway	Colchester	VT	Active
DSH470003AF	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Continence Center, FAH MOB	792 College Parkway	Colchester	VT	Terminated
DSH470003AH	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Orthopedics and Rehabilitation Center - Physical Therapy	192 Tilley Drive	South Burlington	VT	Active
DSH470003AJ	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Aquatic Rehabilitation	32 Malletts Bay Avenue	Winooski	VT	Active
DSH470003AK	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Outpatient Rehabilitation Therapy	790 College Parkway	Colchester	VT	Active
DSH470003AL	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Rehabilitation Therapy - South Burlington	3 Timber Lane	South Burlington	VT	Active
DSH470003AM	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Orthopedics and Rehabilitation Center - Sports Medicine Program	192 Tilley Drive	South Burlington	VT	Active
DSH470003AN	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Orthopedics and Rehabilitation Center - Spine Program	192 Tilley Drive	South Burlington	VT	Active
DSH470003AP	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Speech Language Pathology- Fanny Allen Campus	790 College Parkway	Colchester	VT	Active
DSH470003AQ	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Audiology Center - Fanny Allen Campus	790 College Parkway	Colchester	VT	Active
DSH470003AR	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	UVMMC Dialysis - Berlin	130 Fisher Road	Barre	VT	Active
DSH470003AS	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	UVMMC Dialysis - Rutland	160 Allen Street	Rutland	VT	Active
DSH470003AT	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	UVMMC Dialysis - St. Albans	8 Crest Road	St. Albans	VT	Active
DSH470003AU	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	UVMMC Dialysis - South Burlington	35 Joy Drive	South Burlington	VT	Active
DSH470003AV	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	UVMMC Dialysis - Newport	189 Prouty Drive	Newport	VT	Active
DSH470003AW	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	UVMMC Dialysis - Home Program	35 Joy Drive	South Burlington	VT	Active
DSH470003AX	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Urgent Care	790 College Parkway	Colchester	VT	Active
DSH470003AY	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Comprehensive Pediatric Orthopedic Services and Specialties	192 Tilley Drive	South Burlington	VT	Active
DSH470003AZ	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Pediatric Primary Care - Williston	353 Blair Park Road	Williston	VT	Active
DSH470003BA	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Urology - Fanny Allen Campus	792 College Parkway	Colchester	VT	Active
DSH470003BB	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Pediatric Primary Care - Burlington	1 South Prospect Street	Burlington	VT	Active
DSH470003BC	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Urology - Middlebury	1330 Exchange Street, #103	Middlebury	VT	Active
DSH470003BD	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Clinical Genetics	112 Colchester Avenue	Burlington	VT	Active
DSH470003BE	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	FAH / ANESTHESIA	790 College Parkway	Colchester	VT	Active
DSH470003BF	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	FAH / OR	790 College Parkway	Colchester	VT	Active
DSH470003BG	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Ophthalmology - Tilley Drive	350 Tilley Drive	South Burlington	VT	Active
DSH470003BH	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Driver Rehabilitation Program - Fanny Allen Campus	792 College Parkway	Colchester	VT	Active
DSH470003BJ	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Radiology - Fanny Allen Campus	790 College Parkway	Colchester	VT	Active
DSH470003BK	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Radiology - Tilley Drive	192 Tilley Drive	South Burlington	VT	Active
DSH470003BL	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Neurology - Multiple Sclerosis	1 South Prospect Street	Burlington	VT	Active
DSH470003BM	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	UVMMC - SAN REMO DRIVE / MRI-San Remo Drive	6 SAN REMO DR	SOUTH BURLINGTON	VT	Terminated
DSH470003BN	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Diagnostic Radiology - San Remo Drive	6 San Remo Drive	South Burlington	VT	Active
DSH470003BP	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Orthopedics - San Remo Drive	6 San Remo Drive	South Burlington	VT	Active
DSH470003BQ	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Neurosurgery - Tilley Drive	192 Tilley Drive	South Burlington	VT	Active
DSH470003BR	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Weekend Primary Care	1 South Prospect Street	Burlington	VT	Active
DSH470003BS	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Outpatient Rehabilitation - Medical Office Building - Fanny Allen Campus	792 College Parkway	Colchester	VT	Active
DSH470003BT	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Seneca Center	1 South Prospect Street	Burlington	VT	Active
DSH470003BU	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Neurology - Fanny Allen Campus	790 College Parkway	Colchester	VT	Active
DSH470003BV	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Hematology/Oncology - Tilley Drive	62 Tilley Drive	South Burlington	VT	Active
DSH470003BW	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Comprehensive Pain Program	118 Tilley Drive	South Burlington	VT	Active
DSH470003BX	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Memory Program	792 College Parkway	Colchester	VT	Active
DSH470003BY	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Mountain View Vascular Surgery - Vascular Surgery	354 Mountain View Drive	Colchester	VT	Active
DSH470003BZ	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Adult Infusion Center at South Burlington	118 Tilley Drive	South Burlington	VT	Active
DSH470003CA	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Dermatology - Tilley Drive	350 Tilley Drive	South Burlington	VT	Active
DSH470003E	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Interventional Pain Medicine	62 Tilley Drive	South Burlington	VT	Active
DSH470003F	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Family Medicine - Colchester	883 Blakely Road	Colchester	VT	Active
DSH470003G	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Family Medicine - Milton	28 Center Drive	Milton	VT	Active
DSH470003H	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Family Medicine - South Burlington	3 Timber Lane	South Burlington	VT	Active
DSH470003J	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Family Medicine - Hinesburg	37 Haystack Road	Hinesburg	VT	Active
DSH470003K	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Urgent Care - Infusion Services	790 College Parkway	Colchester	VT	Active
DSH470003L	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Cardiac Rehabilitation	62 Tilley Drive	South Burlington	VT	Active
DSH470003M	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Cardiology - Tilley Drive	62 Tilley Drive	South Burlington	VT	Active
DSH470003N	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Endocrinology	62 Tilley Drive	South Burlington	VT	Active
DSH470003P	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Nephrology - 1 South Prospect Street	1 South Prospect Street	Burlington	VT	Active
DSH470003Q	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Neurology - 1 South Prospect Street	1 South Prospect Street	Burlington	VT	Active
DSH470003R	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Orthopedics and Rehabilitation Center	192 Tilley Drive	South Burlington	VT	Active
DSH470003S	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Physical Medicine and Rehabilitation Services - Tilley Drive	192 Tilley Drive	South Burlington	VT	Active
DSH470003T	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Adult Primary Care - South Burlington	1 Timber Lane	South Burlington	VT	Active
DSH470003U	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Adult Primary Care - Essex	2 Essex Way	Essex Junction	VT	Active
DSH470003V	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Adult Primary Care - Burlington	1 South Prospect Street	Burlington	VT	Active
DSH470003W	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Adult Primary Care - Williston	353 Blair Park Road	Williston	VT	Active
DSH470003X	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Psychiatry - 1 South Prospect Street	1 South Prospect Street	Burlington	VT	Active
DSH470003Z	Child	DSH	UNIVERSITY OF VERMONT MEDICAL CENTER	Addiction Treatment Center	1 South Prospect Street	Burlington	VT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Main Address	Update	Change Request	111 Colchester Avenue Burlington, VT 05401	350 Tilley Drive Suite 201 South Burlington, VT 05403	1/15/2025 11:50 AM
Details	Entity Subname	Update	Change Request	UVMMC Dermatology - Dermatology	Dermatology - Tilley Drive	1/15/2025 11:50 AM
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		McMillian, Wesley Network Vice President of Pharmacy University of Vermont Medical Center, Inc 8028473546	10/21/2024 1:37 PM
Details	340B ID	Update	New Registration		DSH470003CA	10/21/2024 1:37 PM
Details	Entity Subname	Update	New Registration	UVMMC Dermatology	UVMMC Dermatology - Dermatology	10/21/2024 1:37 PM
Dates	Participating Approval Date	Update	New Registration		10/21/2024 1:37:48 PM	10/21/2024 1:37 PM
Details	State	Update	New Registration	Pending	Approved	10/21/2024 1:37 PM
Dates	Signed By Date	Update	New Registration		10/10/2024 12:14:32 PM	10/21/2024 1:37 PM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/21/2024 1:37 PM
Addresses	Main Address	Insert	New Registration		111 Colchester Avenue Burlington, VT 05401	10/9/2024 12:48 PM
Addresses	Billing Address	Insert	New Registration		UNIVERSITY OF VERMONT MEDICAL CENTER PO Box 1870 111 Colchester Avenue Burlington, VT 05402	10/9/2024 12:48 PM
Addresses	Shipping Address	Insert	New Registration		University of Vermont Medical Center Main Campus 111 Colchester Avenue Burlington, VT 05401	10/9/2024 12:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2024 12:48 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0VN0997	10/9/2024 12:48 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VT	10/9/2024 12:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/9/2024 12:48 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		470003	10/9/2024 12:48 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VT	10/9/2024 12:48 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1568419976	10/9/2024 12:48 PM
Medicaid Billing	NPI: State	Insert	New Registration		VT	10/9/2024 12:48 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1659309615	10/9/2024 12:48 PM
Medicaid Billing	NPI: State	Insert	New Registration		VT	10/9/2024 12:48 PM
Contacts	Primary Contact	Insert	New Registration		Beric, Minela Manager, Network 340B & Pharmacy Ops UNIVERSITY OF VERMONT MEDICAL CENTER 8025423455	10/9/2024 12:48 PM
Contacts	Authorizing Official	Insert	New Registration		McMillian, Wesley Network Vice President of Pharmacy University of Vermont Medical Center, Inc 8028473546	10/9/2024 12:48 PM
Details	Assistance Received From Date	Insert	New Registration			10/9/2024 12:48 PM
Details	Assistance Received To Date	Insert	New Registration			10/9/2024 12:48 PM
Details	Last Recertification Date	Insert	New Registration			10/9/2024 12:48 PM
Details	Grant Number	Insert	New Registration			10/9/2024 12:48 PM
Details	340B ID	Insert	New Registration			10/9/2024 12:48 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/9/2024 12:48 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/9/2024 12:48 PM
Details	Medicare Provider Number	Insert	New Registration		470003	10/9/2024 12:48 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF VERMONT MEDICAL CENTER	10/9/2024 12:48 PM
Details	NOFO Number	Insert	New Registration			10/9/2024 12:48 PM
Details	Program Code	Insert	New Registration		DSH	10/9/2024 12:48 PM
Details	Entity Subname	Insert	New Registration		UVMMC Dermatology	10/9/2024 12:48 PM
Dates	Participating Approval Date	Insert	New Registration			10/9/2024 12:48 PM
Details	State	Insert	New Registration		Pending	10/9/2024 12:48 PM
Dates	Registration Date	Insert	New Registration		10/9/2024 12:48:16 PM	10/9/2024 12:48 PM
Dates	Signed By Date	Insert	New Registration			10/9/2024 12:48 PM
Dates	Start Date	Insert	New Registration			10/9/2024 12:48 PM
Terminations	Termination Comments	Insert	New Registration			10/9/2024 12:48 PM
Terminations	Termination Date	Insert	New Registration			10/9/2024 12:48 PM
Terminations	Termination Effective Date	Insert	New Registration			10/9/2024 12:48 PM
Terminations	Termination Reason	Insert	New Registration			10/9/2024 12:48 PM