340B Drug Pricing Program Database


DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER (Active) - information as of 4/27/2025 12:53:22 AM

Main Details
UNIVERSITY OF VERMONT MEDICAL CENTER
Disproportionate Share Hospital
Yes
DSH470003
470003


Additional Details
Active
3/1/2006
4/1/2005
3/1/2006
8/28/2024

Contacts

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

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

Addresses

111 Colchester Avenue
Burlington, VT 05401

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
CommentLast Updated On 
3/1/06 - ADMIN CORR - CHANGED ID FROM DSH05401, 4/1/0603/23/2007
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
VT1012209,0VN0997,472300,470003,1012210,1014262,1014263,473500,473501,473502,473503,4735041013953280,1407867054,1427112861,1508808353,1538186168,1568419976,1568501591,1619031044,1659309615,1841234283,1932143377,1942244462
Shipping Addresses

UNIVERSITY OF VERMONT MEDICAL CENTER
Main Campus
111 Colchester Ave
Burlington, VT 05401

University of Vermont Medical Center
327 Holly Court
Williston, VT 05495-4440

THE UNIVERSITY OF VERMONT MEDICAL CENTER
Fanny Allen Campus
790 College Pkwy
Colchester, VT 05446-3007

UNIVERSITY OF VERMONT MEDICAL CENTER
Outpatient Pharmacy
792 College Pkwy Ste 103
Colchester, VT 05446-3052

UNIVERSITY OF VERMONT MEDICAL CENTER
Outpatient Pharmacy
1 S Prospect St
Burlington, VT 05401-3572

UNIVERSITY OF VERMONT MEDICAL CENTER
Home Infusion Pharmacy
1 S Prospect St Ste 1413
Burlington, VT 05401-3456

University of Vermont Medical Center
Pharmacy
75 Holly Ct
Williston, VT 05495-7247

University of Vermont Health Network
Pharmacy
83 Holly Ct
Williston, VT 05495-7247
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/15/201507/01/2015  05/15/2017
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/15/201507/01/2015  05/15/2017
Contract DetailACCREDO HEALTH GROUP INC201 GREAT CIRCLE ROAD
NASHVILLETN3722804/15/201507/01/2015 10/15/201810/17/2018
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/14/201707/01/2017  05/15/2017
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/15/201507/01/2015 11/07/202311/07/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/15/201507/01/2015  05/15/2017
Contract DetailACCREDO HEALTH GROUP, INC.  PHARMACY
2 BOULDEN CIRCLE SUITE 1 		NEW CASTLEDE1972004/15/201507/01/2015  05/15/2017
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/06/201510/01/2015 01/11/201801/11/2018
Contract DetailACCREDO HEALTH GROUP, INC.45 ROUTE 46 EAST SUITE 609
PINE BROOKNJ0705810/09/201901/01/2020 01/01/202410/10/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/04/202201/21/2022  01/21/2022
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280907/10/201710/01/2017 04/30/202104/30/2021
Contract DetailALARICK INCFAIRFAX PHARMACY 997 MAIN STREET
PO BOX 339 		FAIRFAXVT05454-033910/25/201210/25/2012 09/30/202112/16/2021
Contract DetailAVELLA OF DEER VALLEY23620 N 20TH DR #12
PHOENIXAZ85085-062104/15/201507/01/2015 07/27/202007/29/2020
Contract DetailAVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508510/16/201701/01/2018 07/27/202007/29/2020
Contract DetailAVELLA OF ORLANDO100 TECHNOLOGY PARK STE 155
LAKE MARYFL32746-620504/15/201507/01/2015 07/27/202007/29/2020
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526110/18/202301/01/2024  01/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/16/201501/01/2016  05/15/2017
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/16/201810/01/2018  10/01/2018
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/16/201810/01/2018  10/01/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/16/201501/01/2016  05/15/2017
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/16/201501/01/2016  05/15/2017
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/16/201810/01/2018  10/01/2018
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/16/201501/01/2016  05/15/2017
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813310/16/201501/01/2016  05/15/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237410/16/201501/01/2016  05/15/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/13/202104/19/2021  04/19/2021
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 28550 CABOT DR
SUITE 200 		NOVIMI4837704/14/201707/01/2017 07/31/202211/14/2022
Contract DetailCORAM ALTERNATE SITE SERVICES, INC.DBA CORAM CVS/SPECIALTY INFUSION SERVICE 6 SPRING MILL DR
MALVERNPA1935510/17/202210/26/2022  10/26/2022
Contract DetailCORAM HEALTHCARE CORPORATION OF GREATERDBA CORAM CVS/SPECIALTY INFUSION SERVICE 12 JUPITER LANE
ALBANYNY12205-691804/14/201707/01/2017 09/04/202211/14/2022
Contract DetailCORAM HEALTHCARE CORPORATION OF MASSACHUCORAM CVS/SPECIALTY INFUSION SERVICES 575 UNIVERSITY AVENUE
SUITE 2 		NORWOODMA0206204/14/201707/01/2017 07/25/202211/14/2022
Contract DetailCVS ALBANY, L.L.C.CVS/PHARMACY # 17512 60 SMITHFIELD BLVD
SUITE 49 		PLATTSBURGHNY1290101/15/202101/22/2021  01/22/2021
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/06/202010/14/2020  10/14/2020
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/06/202010/14/2020  10/14/2020
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/13/202104/19/2021  04/19/2021
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/16/201701/01/2018  04/17/2019
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/16/201810/01/2018  10/01/2018
Contract DetailGOLUB CORPORATIONMARKET 32 PHARMACY 168 19 CENTRE DRIVE
PLATTSBURGHNY1290110/04/202210/26/2022  10/26/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #11 800 U.S. ROUTE 302 - BERLIN
BARREVT0564108/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #18 164 SWANTON ROAD
ST ALBANSVT0547808/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #21 82 PEARL STREET
ESSEX JUNCTIONVT0545208/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #22 115B MONKTON ROAD
VERGENNESVT0549108/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #29 308 SHELBURNE ROAD
BURLINGTONVT0540108/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #35 3 CENTRE DRIVE
MILTONVT0546808/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #55 1653 WILLISTON ROAD
SOUTH BURLINGTONVT0540308/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #23 97 MORRISVILLE PLAZA
PO BOX 979 		MORRISVILLEVT0566108/17/201208/17/2012  05/15/2017
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #103 10212 ROUTE 116
HINESBURGVT0546110/16/201701/01/2018  04/17/2019
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #101 80 S MAIN STREET
WATERBURYVT05676-155310/16/201701/01/2018 01/11/201801/11/2018
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #101 80 S MAIN STREET
WATERBURYVT05676-155310/16/201701/01/2018  04/17/2019
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #132 69 MAIN STREET
MONTPELIERVT0560201/11/201804/01/2018  01/11/2018
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #12 3400 STATE ST ROUTE 11
MALONENY1295312/12/202212/13/2022  12/13/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #38 40 COURT STREET
MIDDLEBURYVT0575312/12/202212/13/2022  12/13/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #14 485 EAST MAIN STREET
MALONENY1295312/12/202212/13/2022  12/13/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #86 155 SOUTH MAIN STREET
PO BOX 1 		CAMBRIDGEVT0544412/12/202212/13/2022  12/13/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #40 6 VETERANS LANE
PLATTSBURGHNY1290112/12/202212/13/2022  12/13/2022
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #107 47 EXECUTIVE DRIVE
SHELBURNEVT0548212/12/202212/13/2022  12/13/2022
Contract DetailLAKESIDE PHARMACY INC242 PEARL ST
BURLINGTONVT0540108/01/201208/01/2012 08/31/201810/17/2018
Contract DetailLYNNFIELD DRUG INCDBA FREEDOM FERTILITY PHARMACY 374 MERRIMAC ST STE 100
NEWBURYPORTMA0195004/14/201707/01/2017  05/15/2017
Contract DetailMARBLE WORKS PHARMACYPHARMACY HEALTH SERVICES 99 MAPLE STREET
MIDDLEBURYVT0575310/24/201210/24/2012 01/01/201705/15/2017
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD FOOD & DRUG #8161 1127 NORTH AVENUE SUITE 11
BURLINGTONVT0540807/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #84 935 SHELBURNE ROAD
SOUTH BURLINGTONVT0540307/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 456 S. BARRE RD
BARREVT0564107/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 80 FAIRGROUNDS PLZ
MORRISVILLEVT0566107/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #82 259 US ROUTE 7 SOUTH
MILTONVT0546807/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 260 COURT ST, UNIT 6
MIDDLEBURYVT0575307/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #83 217 DORSET STREET, UNIVERSITY MALL
SOUTH BURLINGTONVT0540307/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #83 21-A ESSEX WAY
ESSEX JUNCTIONVT0545207/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #83 290 HIGHGATE COMMONS ROAD
ST ALBANSVT0547807/14/202007/23/2020  07/23/2020
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #83 78 MARSHALL AVE
WILLISTONVT0549507/14/202007/23/2020  07/23/2020
Contract DetailMAXI GREEN, INC.RITE AID #10321 1184 PRIM ROAD STE 2
COLCHESTERVT0544610/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10319 321 MAIN STREET
WINOOSKIVT0540410/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10324 201 US ROUTE 7 SOUTH
PO BOX 31 		MILTONVT0546810/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10318 39 HINESBURG ROAD
SOUTH BURLINGTONVT0540310/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10317 158 CHERRY STREET
BURLINGTONVT0540110/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10323 75 PEARL STREET
ESSEX JUNCTIONVT0545210/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10325 133 NORTH MAIN STREET SUITE 23
ST. ALBANSVT0547810/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10327 108 CORNERSTONE DRIVE
WILLISTONVT0549510/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10326 30 SHELBURNE SHOPPING PARK
SHELBURNEVT0548210/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10320 1 PRINCE LANE
BRISTOLVT0544310/24/201210/24/2012 01/31/201802/14/2018
Contract DetailMONTPELIER PHARMACY69 MAIN STREET
MONTPELIERVT0560210/18/201210/18/2012 10/15/201710/16/2017
Contract DetailNOBLE HEALTH SERVICES INC.6040 TARBELL ROAD
SYRACUSENY1320607/19/201610/01/2016  05/15/2017
Contract DetailONCOMED PHARMACEUTICAL SERVICES OF MA, LD/B/A ONCO360 335 BEAR HILL RD
STE 2100 		WALTHAMMA0245110/17/201801/01/2019 10/24/201910/25/2019
Contract DetailONCOMED THE ONCOLOGY PHARMACY OF BUFFALOD/B/A ONCO360 140 JOHN JAMES AUDUBON PKWY STE 101
AMHERSTNY1422810/17/201801/01/2019  01/01/2019
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/14/202007/23/2020 01/14/202101/15/2021
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/11/202301/01/2024  01/01/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260110/11/202301/01/2024  01/01/2024
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705801/15/202101/22/2021  01/22/2021
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276501/04/202201/21/2022  01/21/2022
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502901/04/202201/21/2022  01/21/2022
Contract DetailOPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302501/04/202201/21/2022  01/21/2022
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850710/17/202210/26/2022  10/26/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520410/11/202301/01/2024  01/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/14/202007/23/2020  07/23/2020
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824901/04/202201/21/2022  01/21/2022
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/14/202007/23/2020  07/23/2020
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265501/15/202101/22/2021  01/22/2021
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110101/15/202101/22/2021  01/22/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508507/14/202007/14/2020  07/22/2020
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983801/04/202201/21/2022  01/21/2022
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660801/04/202201/21/2022 09/15/202211/01/2022
Contract DetailPRICE CHOPPER OPER CO OF VTPRICE CHOPPER PHARMACY #192 90 CENTER ROAD
ESSEX JUNCTIONVT0545210/04/202210/26/2022  10/26/2022
Contract DetailPRICE CHOPPER OPERATING CO OF VERMONT INPRICE CHOPPER PHARMACY 127 170 SWANTON ROAD
PO BOX 434 		ST ALBANSVT0547810/04/202210/26/2022  10/26/2022
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999210/16/201701/01/2018 08/31/202203/20/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/16/201501/01/2016  05/15/2017
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/13/202104/19/2021  04/19/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/13/202104/19/2021  04/19/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/13/202104/19/2021  04/19/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY # 2919 126 EIGHTH AVE.
NEW YORKNY1001112/12/202212/13/2022  12/13/2022
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255010/18/202301/01/2024  01/01/2024
Contract DetailRITE AID OF VERMONT, INC.RITE AID #4827 9 SUSIE WILSON ROAD
ESSEX JUNCTIONVT0545210/24/201210/24/2012 01/31/201802/14/2018
Contract DetailRITE AID OF VERMONT, INC.RITE AID #4272 1024 NORTH AVENUE
BURLINGTONVT0540810/24/201210/24/2012 01/31/201802/14/2018
Contract DetailSHAWS SUPERMARKETS INCSHAWS PHARMACY #2518 71 BOXWOOD ST
WILLISTONVT0549504/16/201807/01/2018  04/16/2018
Contract DetailSHAWS SUPERMARKETS INCSHAWS PHARMACY #0117 570 SHELBURNE RD
BURLINGTONVT0540104/16/201807/01/2018  04/16/2018
Contract DetailSHAWS SUPERMARKETS INCSHAWS PHARMACY #0615 66 MOUNTAIN VIEW DR
COLCHESTERVT0544604/16/201807/01/2018  04/16/2018
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022310/17/201801/01/2019 10/24/201910/25/2019
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104210/17/201801/01/2019  01/01/2019
Contract DetailSORKIN'S RX LTDD/B/A CAREMED PHARMACEUTICAL SERVICES 1985 MARCUS AVE STE 130
NEW HYDE PARKNY11042-202410/17/201801/01/2019  01/01/2019
Contract DetailTHE GOLUB CORPORATIONMARKET 32 PHARMACY 165 BURLINGTON SHOPPING CENTER
595 SHELBURNE RD 		BURLINGTONVT0540110/04/202210/26/2022  10/26/2022
Contract DetailTOTAL CARE RX, INC.WORLD'S FAIR PHARMACY 22310 UNION TPKE
OAKLAND GARDENSNY11364-364501/15/202101/22/2021  01/22/2021
Contract DetailVANDERBILT HEALTH PHARMACY GROUP718 MELROSE AVE
NASHVILLETN37211-372110/16/201901/01/2020 10/19/202211/01/2022
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01052 7 ESSEX WAY
ESSEXVT0545210/05/201210/05/2012  05/15/2017
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 7103 49 WRIGHT AVE
WILLISTONVT05495-441902/22/201304/01/2013  05/15/2017
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10216 69 MOUNTIAN VIEW DRIVE
COLCHESTERVT05446-591910/06/201601/01/2017  05/15/2017
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10197 13 VT ROUTE 15 E
MORRISVILLEVT0566110/06/202010/14/2020  10/14/2020
Contract DetailVERMONT CVS PHARMACY, L.L.C.CVS/PHARMACY #11037 35 CHURCH ST
BURLINGTONVT0540110/06/202010/14/2020  10/14/2020
Contract DetailVERMONT CVS PHARMACY, L.L.C.CVS/PHARMACY #10690 1 DORSET STREET
SOUTH BURLINGTONVT0540310/06/202010/14/2020  10/14/2020
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00673 31 S MAIN ST
RUTLANDVT05701-504112/12/202212/13/2022  12/13/2022
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10127 1634 US ROUTE 302
BARREVT05641-232212/12/202212/13/2022  12/13/2022
Contract DetailVERMONT FAMILY PHARMACY INC1219 NORTH AVE
BURLINGTONVT05408-274710/24/201210/24/2012  05/15/2017
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/07/202007/23/2020  07/23/2020
Contract DetailWAL-MART PHARMACY 10-2224863 HARVEST LANE
WILLISTONVT0549507/07/202007/23/2020  07/23/2020
Contract DetailWAL-MART PHARMACY 10-2682282 BERLIN MALL ROAD UNIT #1
BERLINVT0560207/07/202007/23/2020  07/23/2020
Contract DetailWAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281907/07/202007/23/2020  07/23/2020
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/07/202007/23/2020  07/23/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #11526 514 FARRELL ST.
BURLINGTONVT05401-690710/16/201701/01/2018  04/17/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 301 CORNELIA ST.
PLATTSBURGHNY12901-252310/16/201701/01/2018  04/17/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17471 9 SUSIE WILSON RD
ESSEX JUNCTIONVT0545202/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19570 1024 NORTH AVE
BURLINGTONVT0540802/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17475 108 CORNERSTONE DR
WILLISTONVT0549502/15/201802/15/2018 03/21/202305/16/2023
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #18325 30 SHELBURNE SHOPPING PARK
SHELBURNEVT0548202/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19795 133 N MAIN ST
SUITE 23 		SAINT ALBANSVT05478-173502/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17747 201 US ROUTE 7 SOUTH
MILTONVT0546802/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17749 75 PEARL ST
ESSEX JUNCTIONVT0545202/15/201802/15/2018 02/23/202303/07/2023
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17183 1184 PRIM RD
SUITE 2 		COLCHESTERVT0544602/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #18043 1 PRINCE LN
BRISTOLVT0544302/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17485 321 MAIN ST STE B
WINOOSKIVT0540402/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17447 39 HINESBURG RD
SOUTH BURLINGTONVT0540302/15/201802/15/2018  02/15/2018
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19449 158 CHERRY ST
BURLINGTONVT0540102/15/201802/15/2018 11/14/202312/14/2023
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #18375 263 COURT ST
MIDDLEBURYVT0575301/13/202201/21/2022  01/21/2022
Contract DetailWalgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204801/09/202301/24/2023  01/24/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/16/201701/01/2018  04/17/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700810/16/201701/01/2018 10/21/202112/16/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/16/201701/01/2018  04/17/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/16/201701/01/2018  04/17/2019
Contract DetailWALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528610/16/201701/01/2018  04/17/2019
Contract DetailWALMART PHARMACY 10-2332700 TUCKERS WAY
SAINT ALBANSVT0547807/07/202007/23/2020  07/23/2020
Contract DetailWALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A 		ROGERSAR7275604/06/202307/01/2023  07/01/2023
Contract DetailWalmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/11/202301/01/2024  01/01/2024
Contract DetailWATERBURY PHARMACY149 SOUTH MAIN STREET
WATERBURYVT05676-151610/18/201210/18/2012 10/15/201710/16/2017
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH470003AAChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERBariatric Surgery - Williston353 Blair Park RoadWillistonVTActive
DSH470003ABChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERPlastic, Reconstructive and Cosmetic Surgery354 Mountain View DriveColchesterVTActive
DSH470003ACChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERTransplant Surgery1 South Prospect StreetBurlingtonVTActive
DSH470003AEChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERPelvic Medicine and Reconstructive Surgery792 College ParkwayColchesterVTActive
DSH470003AFChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERContinence Center, FAH MOB792 College ParkwayColchesterVTTerminated
DSH470003AHChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROrthopedics and Rehabilitation Center - Physical Therapy192 Tilley DriveSouth BurlingtonVTActive
DSH470003AJChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAquatic Rehabilitation32 Malletts Bay AvenueWinooskiVTActive
DSH470003AKChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROutpatient Rehabilitation Therapy790 College ParkwayColchesterVTActive
DSH470003ALChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERRehabilitation Therapy - South Burlington3 Timber LaneSouth BurlingtonVTActive
DSH470003AMChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROrthopedics and Rehabilitation Center - Sports Medicine Program192 Tilley DriveSouth BurlingtonVTActive
DSH470003ANChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROrthopedics and Rehabilitation Center - Spine Program192 Tilley DriveSouth BurlingtonVTActive
DSH470003APChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERSpeech Language Pathology- Fanny Allen Campus790 College ParkwayColchesterVTActive
DSH470003AQChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAudiology Center - Fanny Allen Campus790 College ParkwayColchesterVTActive
DSH470003ARChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUVMMC Dialysis - Berlin130 Fisher RoadBarreVTActive
DSH470003ASChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUVMMC Dialysis - Rutland160 Allen StreetRutlandVTActive
DSH470003ATChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUVMMC Dialysis - St. Albans8 Crest RoadSt. AlbansVTActive
DSH470003AUChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUVMMC Dialysis - South Burlington35 Joy DriveSouth BurlingtonVTActive
DSH470003AVChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUVMMC Dialysis - Newport189 Prouty DriveNewportVTActive
DSH470003AWChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUVMMC Dialysis - Home Program35 Joy DriveSouth BurlingtonVTActive
DSH470003AXChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUrgent Care790 College ParkwayColchesterVTActive
DSH470003AYChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERComprehensive Pediatric Orthopedic Services and Specialties192 Tilley DriveSouth BurlingtonVTActive
DSH470003AZChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERPediatric Primary Care - Williston353 Blair Park RoadWillistonVTActive
DSH470003BAChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUrology - Fanny Allen Campus792 College ParkwayColchesterVTActive
DSH470003BBChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERPediatric Primary Care - Burlington1 South Prospect StreetBurlingtonVTActive
DSH470003BCChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUrology - Middlebury1330 Exchange Street, #103MiddleburyVTActive
DSH470003BDChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERClinical Genetics112 Colchester AvenueBurlingtonVTActive
DSH470003BEChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERFAH / ANESTHESIA790 College ParkwayColchesterVTActive
DSH470003BFChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERFAH / OR790 College ParkwayColchesterVTActive
DSH470003BGChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROphthalmology - Tilley Drive350 Tilley DriveSouth BurlingtonVTActive
DSH470003BHChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERDriver Rehabilitation Program - Fanny Allen Campus792 College ParkwayColchesterVTActive
DSH470003BJChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERRadiology - Fanny Allen Campus790 College ParkwayColchesterVTActive
DSH470003BKChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERRadiology - Tilley Drive192 Tilley DriveSouth BurlingtonVTActive
DSH470003BLChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERNeurology - Multiple Sclerosis1 South Prospect StreetBurlingtonVTActive
DSH470003BMChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUVMMC - SAN REMO DRIVE / MRI-San Remo Drive6 SAN REMO DRSOUTH BURLINGTONVTTerminated
DSH470003BNChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERDiagnostic Radiology - San Remo Drive6 San Remo DriveSouth BurlingtonVTActive
DSH470003BPChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROrthopedics - San Remo Drive6 San Remo DriveSouth BurlingtonVTActive
DSH470003BQChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERNeurosurgery - Tilley Drive192 Tilley DriveSouth BurlingtonVTActive
DSH470003BRChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERWeekend Primary Care1 South Prospect StreetBurlingtonVTActive
DSH470003BSChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROutpatient Rehabilitation - Medical Office Building - Fanny Allen Campus792 College ParkwayColchesterVTActive
DSH470003BTChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERSeneca Center1 South Prospect StreetBurlingtonVTActive
DSH470003BUChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERNeurology - Fanny Allen Campus790 College ParkwayColchesterVTActive
DSH470003BVChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERHematology/Oncology - Tilley Drive62 Tilley DriveSouth BurlingtonVTActive
DSH470003BWChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERComprehensive Pain Program118 Tilley DriveSouth BurlingtonVTActive
DSH470003BXChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERMemory Program792 College ParkwayColchesterVTActive
DSH470003BYChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERMountain View Vascular Surgery - Vascular Surgery354 Mountain View DriveColchesterVTActive
DSH470003BZChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAdult Infusion Center at South Burlington118 Tilley DriveSouth BurlingtonVTActive
DSH470003CAChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERDermatology - Tilley Drive350 Tilley DriveSouth BurlingtonVTActive
DSH470003EChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERInterventional Pain Medicine62 Tilley DriveSouth BurlingtonVTActive
DSH470003FChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERFamily Medicine - Colchester883 Blakely RoadColchesterVTActive
DSH470003GChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERFamily Medicine - Milton28 Center DriveMiltonVTActive
DSH470003HChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERFamily Medicine - South Burlington3 Timber LaneSouth BurlingtonVTActive
DSH470003JChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERFamily Medicine - Hinesburg37 Haystack RoadHinesburgVTActive
DSH470003KChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERUrgent Care - Infusion Services790 College ParkwayColchesterVTActive
DSH470003LChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERCardiac Rehabilitation62 Tilley DriveSouth BurlingtonVTActive
DSH470003MChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERCardiology - Tilley Drive62 Tilley DriveSouth BurlingtonVTActive
DSH470003NChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEREndocrinology62 Tilley DriveSouth BurlingtonVTActive
DSH470003PChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERNephrology - 1 South Prospect Street1 South Prospect StreetBurlingtonVTActive
DSH470003QChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERNeurology - 1 South Prospect Street1 South Prospect StreetBurlingtonVTActive
DSH470003RChildDSHUNIVERSITY OF VERMONT MEDICAL CENTEROrthopedics and Rehabilitation Center192 Tilley DriveSouth BurlingtonVTActive
DSH470003SChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERPhysical Medicine and Rehabilitation Services - Tilley Drive192 Tilley DriveSouth BurlingtonVTActive
DSH470003TChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAdult Primary Care - South Burlington1 Timber LaneSouth BurlingtonVTActive
DSH470003UChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAdult Primary Care - Essex2 Essex WayEssex JunctionVTActive
DSH470003VChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAdult Primary Care - Burlington1 South Prospect StreetBurlingtonVTActive
DSH470003WChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAdult Primary Care - Williston353 Blair Park RoadWillistonVTActive
DSH470003XChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERPsychiatry - 1 South Prospect Street1 South Prospect StreetBurlingtonVTActive
DSH470003ZChildDSHUNIVERSITY OF VERMONT MEDICAL CENTERAddiction Treatment Center1 South Prospect StreetBurlingtonVTActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateProfile Change RequestBeric, Minela Manager, Network 340B & Pharmacy Ops UNIVERSITY OF VERMONT MEDICAL CENTER 8028477567Beric, Minela Manager, Network 340B & Pharmacy Ops UNIVERSITY OF VERMONT MEDICAL CENTER 80254234559/24/2024 4:16 PM
AddressesShipping AddressDeleteRecertificationUniversity of Vermont Medical Center 75 Holly Court Willistion, VT 05495 8/28/2024 12:34 PM
AddressesShipping AddressDeleteRecertificationUniversity of Vermont Medical Center Pharmacy 83 Holly Ct Williston, VT 05495-7247 8/28/2024 12:34 PM
AddressesShipping AddressInsertRecertification UNIVERSITY OF VERMONT MEDICAL CENTER Outpatient Pharmacy 792 College Pkwy Ste 103 Colchester, VT 05446-30528/28/2024 12:34 PM
AddressesShipping AddressInsertRecertification UNIVERSITY OF VERMONT MEDICAL CENTER Outpatient Pharmacy 1 S Prospect St Burlington, VT 05401-35728/28/2024 12:34 PM
AddressesShipping AddressInsertRecertification UNIVERSITY OF VERMONT MEDICAL CENTER Home Infusion Pharmacy 1 S Prospect St Ste 1413 Burlington, VT 05401-34568/28/2024 12:34 PM
AddressesShipping AddressInsertRecertification University of Vermont Medical Center Pharmacy 75 Holly Ct Williston, VT 05495-72478/28/2024 12:34 PM
AddressesShipping AddressInsertRecertification University of Vermont Health Network Pharmacy 83 Holly Ct Williston, VT 05495-72478/28/2024 12:34 PM
AddressesShipping AddressDeleteRecertificationUNIVERSITY OF VERMONT MEDICAL CENTER University Health Center 1 South Prospect street Burlington, VT 05401 8/28/2024 12:34 PM
AddressesShipping AddressDeleteRecertificationUNIVERSITY OF VERMONT MEDICAL CENTER Fanny Allen Campus 792 College Parkway- Suite 103 Colchester, VT 05446-3052 8/28/2024 12:34 PM
AddressesShipping AddressDeleteRecertificationUNIVERSITY OF VERMONT MEDICAL CENTER Infusion Program 1 South Prospect Street, Suite 1413 Burlington, VT 05401 8/28/2024 12:34 PM
DetailsLast Recertification DateUpdateRecertification9/5/2023 11:33:49 AM8/28/2024 12:34:31 PM8/28/2024 12:34 PM
AddressesShipping AddressUpdateChange RequestUNIVERSITY OF VERMONT MEDICAL CENTER Fanny Allen Campus 790 College Parkway Suite G022 Colchester, VT 05446-3007THE UNIVERSITY OF VERMONT MEDICAL CENTER Fanny Allen Campus 790 College Pkwy Colchester, VT 05446-30074/30/2024 12:26 PM
AddressesShipping AddressInsertChange Request UNIVERSITY OF VERMONT MEDICAL CENTER Fanny Allen Campus 790 College Parkway Suite G022 Colchester, VT 05446-30074/29/2024 1:08 PM
ContactsPrimary ContactUpdateChange RequestBergeron, Gary Paul Pharmacy Supervisor University of Vermont Medical Center 8028473962Beric, Minela Manager, Network 340B & Pharmacy Ops UNIVERSITY OF VERMONT MEDICAL CENTER 802847756711/1/2023 1:06 PM
ContactsAuthorizing OfficialUpdateAO Change RequestOliver, Christina VP of Clinical Services University of Vermont Medical Center 8028472805McMillian, Wesley Network Vice President of Pharmacy University of Vermont Medical Center, Inc 802847354611/1/2023 10:23 AM
AddressesShipping AddressInsertChange Request University of Vermont Medical Center Pharmacy 83 Holly Ct Williston, VT 05495-724710/27/2023 7:23 AM
DetailsLast Recertification DateUpdateRecertification9/8/2022 9:03:42 AM9/5/2023 11:33:49 AM9/5/2023 11:33 AM
DetailsLast Recertification DateUpdateRecertification8/31/2021 2:17:25 PM9/8/2022 9:03:42 AM9/8/2022 9:03 AM
DetailsLast Recertification DateUpdateRecertification9/9/2020 10:03:55 AM8/31/2021 2:17:25 PM8/31/2021 2:17 PM
AddressesShipping AddressInsertChange Request University of Vermont Medical Center 75 Holly Court Willistion, VT 054953/16/2021 10:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1568419976 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1659309615 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 10139532809/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 14078670549/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 14271128619/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 15088083539/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 15381861689/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 15684199769/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 15685015919/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 16190310449/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 16593096159/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 18412342839/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 19321433779/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberInsertRecertification 19422444629/9/2020 10:03 AM
Medicaid BillingNPI: StateInsertRecertification VT9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1508808353 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1932143377 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1942244462 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1841234283 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1013953280 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1538186168 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1427112861 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1619031044 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1407867054 ( ) 9/9/2020 10:03 AM
Medicaid BillingNPI: NumberDeleteRecertification1568501591 ( ) 9/9/2020 10:03 AM
DetailsLast Recertification DateUpdateRecertification8/29/2019 1:11:29 PM9/9/2020 10:03:55 AM9/9/2020 10:03 AM
AddressesShipping AddressInsertChange Request University of Vermont Medical Center 327 Holly Court Williston, VT 05495-44402/11/2020 1:07 PM
AddressesBilling AddressUpdateChange RequestUNIVERSITY OF VERMONT MEDICAL CENTER PO Box 1807 Burlington, VT 05402UNIVERSITY OF VERMONT MEDICAL CENTER PO Box 1870 111 Colchester Avenue Burlington, VT 0540210/18/2019 2:25 PM
DetailsLast Recertification DateUpdateRecertification8/16/2018 11:22:15 AM8/29/2019 1:11:29 PM8/29/2019 1:11 PM
AddressesMain AddressUpdateChange Request 111 Colchester Ave BURLINGTON, VT 05401 111 Colchester Avenue Burlington, VT 054015/9/2019 1:41 PM
ContactsPrimary ContactUpdateProfile Change RequestBergeron, Gary Paul Pharamcy Supervisor UVMMC 8028473962Bergeron, Gary Paul Pharmacy Supervisor University of Vermont Medical Center 80284739625/8/2019 10:25 AM
DetailsLast Recertification DateUpdateRecertification11/21/2017 11:55:31 AM8/16/2018 11:22:15 AM8/16/2018 11:22 AM
ContactsPrimary ContactUpdateProfile Change RequestBergeron, Gary paul Pharamcy Supervisor UVMMC 8028473962Bergeron, Gary Paul Pharamcy Supervisor UVMMC 80284739626/28/2018 10:22 AM
Medicaid BillingNPI: NumberInsertChange Request 19321433775/9/2018 3:29 PM
Medicaid BillingNPI: NumberInsertChange Request 19422444625/9/2018 3:29 PM
Medicaid BillingNPI: NumberInsertChange Request 18412342835/9/2018 3:29 PM
Medicaid BillingNPI: NumberInsertChange Request 10139532805/9/2018 3:29 PM
Medicaid BillingNPI: NumberInsertChange Request 15381861685/9/2018 3:29 PM
DetailsLast Recertification DateUpdateRecertification9/2/2016 12:00:00 AM11/21/2017 11:55:31 AM11/21/2017 11:55 AM
ContactsPrimary ContactUpdateRecertificationBergeron, Gary Pharamcy Supervisor UVMMC 8028473962Bergeron, Gary paul Pharamcy Supervisor UVMMC 802847396211/21/2017 9:59 AM
ContactsPrimary ContactUpdate Bergeron, Gary Pharamcy Supervisor 8028473962Bergeron, Gary Pharamcy Supervisor UVMMC 802847396210/10/2017 3:17 PM
ContactsAuthorizing OfficialUpdate Oliver, Christina VP of Clinical Services 8028472805Oliver, Christina VP of Clinical Services University of Vermont Medical Center 802847280510/9/2017 2:57 PM
ContactsPrimary ContactUpdate MCBRIDE, KAREN DIRECTOR, PHARMACY SERVICES 8028473546Bergeron, Gary Pharamcy Supervisor 80284739628/3/2017 10:40 AM
ContactsAuthorizing OfficialUpdate Felis, Sandra COO/CNO 8028470171Oliver, Christina VP of Clinical Services 80284728058/3/2017 10:40 AM
AddressesMain AddressInsert   111 Colchester Ave BURLINGTON, VT 054017/27/2017 12:11 PM
AddressesBilling AddressInsert  UNIVERSITY OF VERMONT MEDICAL CENTER PO Box 1807 BURLINGTON, VT 054027/27/2017 12:11 PM
AddressesShipping AddressInsert  UNIVERSITY OF VERMONT MEDICAL CENTER University Health Center 1 South Prospect street Burlington, VT 054017/27/2017 12:11 PM
AddressesShipping AddressInsert  UNIVERSITY OF VERMONT MEDICAL CENTER Fanny Allen Campus 792 College Parkway- Suite 103 Colchester, VT 05446-30527/27/2017 12:11 PM
AddressesShipping AddressInsert  UNIVERSITY OF VERMONT MEDICAL CENTER Main Campus 111 Colchester Ave Burlington, VT 054017/27/2017 12:11 PM
AddressesShipping AddressInsert  UNIVERSITY OF VERMONT MEDICAL CENTER Infusion Program 1 South Prospect Street, Suite 1413 Burlington, VT 054017/27/2017 12:11 PM
Medicaid BillingNPI: NumberInsert  15088083537/27/2017 12:11 PM
DetailsLast Recertification DateUpdate 8/19/2015 12:00:00 AM9/2/2016 12:00:00 AM9/2/2016 8:41 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/6/2016 12:00 PM
Medicaid BillingMedicaid: NumberInsert  4735004/6/2016 12:00 PM
Medicaid BillingMedicaid: StateInsert  VT4/6/2016 12:00 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/6/2016 12:00 PM
Medicaid BillingMedicaid: NumberInsert  4735014/6/2016 12:00 PM
Medicaid BillingMedicaid: StateInsert  VT4/6/2016 12:00 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/6/2016 12:00 PM
Medicaid BillingMedicaid: NumberInsert  4735024/6/2016 12:00 PM
Medicaid BillingMedicaid: StateInsert  VT4/6/2016 12:00 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/6/2016 12:00 PM
Medicaid BillingMedicaid: NumberInsert  4735034/6/2016 12:00 PM
Medicaid BillingMedicaid: StateInsert  VT4/6/2016 12:00 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/6/2016 12:00 PM
Medicaid BillingMedicaid: NumberInsert  4735044/6/2016 12:00 PM
Medicaid BillingMedicaid: StateInsert  VT4/6/2016 12:00 PM
ContactsPrimary ContactInsert  MCBRIDE, KAREN DIRECTOR, PHARMACY SERVICES 80284735464/6/2016 12:00 PM
DetailsLast Recertification DateUpdate 9/3/2014 12:00:00 AM8/19/2015 12:00:00 AM8/19/2015 9:30 AM
ContactsAuthorizing OfficialUpdate Holder, Sophia G. Interim CFO 8028478078Felis, Sandra COO/CNO 802847017111/20/2014 9:52 AM
DetailsEntity NameUpdate FLETCHER ALLEN HEALTH CAREUNIVERSITY OF VERMONT MEDICAL CENTER11/13/2014 2:11 PM
DetailsLast Recertification DateUpdate 9/3/2013 12:00:00 AM9/3/2014 12:00:00 AM9/3/2014 9:22 PM
ContactsAuthorizing OfficialInsert  Holder, Sophia G. Interim CFO 80284780783/31/2014 11:46 AM
Medicaid BillingNPI: NumberInsert  15684199763/31/2014 11:46 AM
Medicaid BillingNPI: NumberInsert  16593096153/31/2014 11:46 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/3/2013 12:00:00 AM9/3/2013 8:52 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False2/22/2013 6:34 PM
Medicaid BillingMedicaid: NumberInsert  10122102/22/2013 6:34 PM
Medicaid BillingMedicaid: StateInsert  VT2/22/2013 6:34 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False2/22/2013 6:34 PM
Medicaid BillingMedicaid: NumberInsert  10142622/22/2013 6:34 PM
Medicaid BillingMedicaid: StateInsert  VT2/22/2013 6:34 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False2/22/2013 6:34 PM
Medicaid BillingMedicaid: NumberInsert  10142632/22/2013 6:34 PM
Medicaid BillingMedicaid: StateInsert  VT2/22/2013 6:34 PM
Medicaid BillingNPI: NumberInsert  16190310442/22/2013 6:34 PM
Medicaid BillingNPI: NumberInsert  14078670542/22/2013 6:34 PM
Medicaid BillingNPI: NumberInsert  15685015912/22/2013 6:34 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/24/2013 9:19 AM
Medicaid BillingMedicaid: NumberInsert  0VN09971/24/2013 9:19 AM
Medicaid BillingMedicaid: StateInsert  VT1/24/2013 9:19 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/24/2013 9:19 AM
Medicaid BillingMedicaid: NumberInsert  4723001/24/2013 9:19 AM
Medicaid BillingMedicaid: StateInsert  VT1/24/2013 9:19 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/24/2013 9:19 AM
Medicaid BillingMedicaid: NumberInsert  4700031/24/2013 9:19 AM
Medicaid BillingMedicaid: StateInsert  VT1/24/2013 9:19 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False12/4/2012 11:03 AM
Medicaid BillingMedicaid: NumberInsert  101220912/4/2012 11:03 AM
Medicaid BillingMedicaid: StateInsert  VT12/4/2012 11:03 AM
Medicaid BillingNPI: NumberInsert  142711286112/4/2012 11:03 AM
DetailsEntity SubnameUpdate OUTPATIENT PHARMACY 12/4/2012 11:03 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/29/2012 12:15 PM
DetailsLast Recertification DateInsert   3/23/2007 12:20 PM
DetailsGrant NumberInsert   3/23/2007 12:20 PM
Details340B IDInsert  DSH4700033/23/2007 12:20 PM
DetailsIs Authorizing Official EHB DataInsert   3/23/2007 12:20 PM
DatesLast Date That 340B Drugs PurchasedInsert   3/23/2007 12:20 PM
DetailsMedicare Provider NumberInsert  4700033/23/2007 12:20 PM
DetailsEntity NameInsert  FLETCHER ALLEN HEALTH CARE3/23/2007 12:20 PM
DetailsProgram CodeInsert  DSH3/23/2007 12:20 PM
DetailsEntity SubnameInsert  OUTPATIENT PHARMACY3/23/2007 12:20 PM
DatesParticipating Approval DateInsert  3/1/2006 12:00:00 AM3/23/2007 12:20 PM
DetailsStateInsert  Active3/23/2007 12:20 PM
DatesRegistration DateInsert  3/1/2006 12:00:00 AM3/23/2007 12:20 PM
DatesSigned By DateInsert  1/17/2006 12:00:00 AM3/23/2007 12:20 PM
DatesStart DateInsert  4/1/2005 12:00:00 AM3/23/2007 12:20 PM
TerminationsTermination CommentsInsert   3/23/2007 12:20 PM
TerminationsTermination DateInsert   3/23/2007 12:20 PM
TerminationsTermination Effective DateInsert   3/23/2007 12:20 PM
TerminationsTermination ReasonInsert   3/23/2007 12:20 PM
DetailsComments PublicInsert  3/1/06 - ADMIN CORR - CHANGED ID FROM DSH05401, 4/1/063/23/2007 12:20 PM