340B Drug Pricing Program Database


CHC10611-00 Lamoille Health Partners, Inc. (Active) - information as of 6/28/2025 12:13:19 AM

Main Details
Lamoille Health Partners, Inc.
ADMINISTRATIVE OFFICE
HRSA-Funded Health Center
BPS-H80-018289
CHC10611-00
H80CS10611


Additional Details
Active
6/7/2010
4/1/2008
3/11/2008
2/18/2025

Contacts

Lamoille Health Partners
Susan Bartlett, Interim Chief Executive Officer
(802) 888-0895

Lamoille Health Partners
Megan Lapan, Corporate Compliance Officer & Risk Manager
(802) 888-0903

Addresses

609 Washington Highway
MORRISVILLE, VT 05661

Lamoille Health Partners
PO Box 749
Morrisville, VT 05661


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
VT 1124436332,1639127681,1770541567,1851349484,1891013793
Shipping Addresses

Lamoille Health Partners, Inc. DBA: Lamoille Health Pharmacy
1878 Mountain Road
Stowe, VT 05672
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/15/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/15/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/15/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522601/15/202404/01/2024  04/01/2024
Contract DetailCOMMUNITY HEALTH PHARMACY158 BRENTWOOD DR STE 6
COLCHESTERVT05446-799410/15/200810/15/2008  03/28/2013
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/13/202107/01/2021  07/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/13/202107/01/2021  07/01/2021
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654101/15/202404/01/2024  04/01/2024
Contract DetailGENOA HEALTHCARE LLC72 HARREL ST STE A03
MORRISVILLEVT0566110/14/202401/01/2025  01/01/2025
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #23 97 MORRISVILLE PLAZA
PO BOX 979 		MORRISVILLEVT0566108/31/201208/31/2012  03/28/2013
Contract DetailKPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #86 155 SOUTH MAIN STREET
PO BOX 1 		CAMBRIDGEVT0544401/23/202304/01/2023  04/01/2023
Contract DetailKPH HEALTHCARE SERVICES, INC.DBA: KINNEY DRUGS CF 471 E MAIN ST
UNIT 5 		GOUVERNEURNY1364207/15/202410/01/2024  10/01/2024
Contract DetailMARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 80 FAIRGROUNDS PLZ
MORRISVILLEVT0566107/15/202110/01/2021  10/01/2021
Contract DetailMAXI GREEN, INC.RITE AID #10330 48 CONGRESS STREET
PO BOX 731 		MORRISVILLEVT0566111/02/201211/02/2012 01/31/201802/14/2018
Contract DetailMAXI GREEN, INC.RITE AID #10336 82 ROUTE 15 WEST
HARDWICKVT0584311/02/201211/02/2012 01/31/201802/14/2018
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/15/202404/01/2024  04/01/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/15/202404/01/2024  04/01/2024
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/15/202404/01/2024  04/01/2024
Contract DetailSHAWS SUPERMARKETS INCSHAWS PHARMACY #0649 820 WATERBURY STOWE RD
WATERBURYVT0567610/17/201901/01/2020  01/01/2020
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10197 13 VT ROUTE 15 E
MORRISVILLEVT0566110/12/201601/01/2017  10/12/2016
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10127 1634 US ROUTE 302
BARREVT05641-232210/15/202001/01/2021  01/01/2021
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01052 7 ESSEX WAY
ESSEXVT0545210/15/202001/01/2021  01/01/2021
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10216 69 MOUNTIAN VIEW DRIVE
COLCHESTERVT05446-591904/13/202107/01/2021  07/01/2021
Contract DetailVERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 7103 49 WRIGHT AVE
WILLISTONVT05495-441904/13/202107/01/2021  07/01/2021
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #18977 48 CONGRESS ST
MORRISVILLEVT0566102/15/201802/15/2018 03/21/202304/19/2023
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17185 82 VT ROUTE 15 W
HARDWICKVT0584302/15/201802/15/2018 09/30/202410/14/2024
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17625 412 BROAD ST
LYNDONVILLEVT0585110/14/202401/01/2025  01/01/2025
Contract DetailWalgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204807/10/202310/01/2023  10/01/2023
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC10611-00ActiveBPS-H80-018289Lamoille Health Partners, Inc.ADMINISTRATIVE OFFICE609 Washington Highway MORRISVILLEVT
CHC10611-01ActiveBPS-H80-007669Lamoille Health Partners, Inc.Lamoille Health Behavioral Health & Wellness607 WASHINGTON HIGHWAY MORRISVILLEVT
CHC10611-03ActiveBPS-H80-018289Lamoille Health Partners, Inc.Lamoille Health Family Medicine, Morrisville609 WASHINGTON HIGHWAY MORRISVILLEVT
CHC10611-04ActiveBPS-H80-007670Lamoille Health Partners, Inc.Lamoille Health Family Medicine, Stowe1878 MOUNTAIN ROAD, STE 3 STOWEVT
CHC10611-05TerminatedBPS-H80-018289COPLEY PROFESSIONAL SERVICES GROUP, INC.Community Health Services609 Washington Highway MorrisvilleVT
CHC10611-06ActiveBPS-H80-027773Lamoille Health Partners, Inc.Lamoille Health Family Dentistry66 Morrisville Plz MorrisvilleVT
CHC10611-07ActiveBPS-H80-037857LAMOILLE HEALTH PARTNERS INCLamoille Health Family Medicine - Cambridge272 N Main Street, Unit 101 CambridgeVT
CHC10611-08ActiveBPS-H80-038947LAMOILLE HEALTH PARTNERS INCLamoille Health Family Dentistry Mobile Unit609 Washington Hwy MorrisvilleVT
CHC10611-09ActiveBPS-H80-035468LAMOILLE HEALTH PARTNERS INCJohnson Elementary School57 College Hill Road JohnsonVT
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC10611-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CHC10611-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CHC10611-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024  
CHC10611-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/01/2024  
CHC10611-00COMMUNITY HEALTH PHARMACY158 BRENTWOOD DR STE 6
COLCHESTERVT05446-799410/15/2008  
CHC10611-01COMMUNITY HEALTH PHARMACY158 BRENTWOOD DR STE 6
COLCHESTERVT05446-799410/15/2008  
CHC10611-03COMMUNITY HEALTH PHARMACY158 BRENTWOOD DR STE 6
COLCHESTERVT05446-799410/15/2008  
CHC10611-04COMMUNITY HEALTH PHARMACY158 BRENTWOOD DR STE 6
COLCHESTERVT05446-799410/15/2008  
CHC10611-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870607/01/2021  
CHC10611-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005607/01/2021  
CHC10611-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654104/01/2024  
CHC10611-00GENOA HEALTHCARE LLC72 HARREL ST STE A03
MORRISVILLEVT0566101/01/2025  
CHC10611-00KPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #23 97 MORRISVILLE PLAZA
PO BOX 979 		MORRISVILLEVT0566108/31/2012  
CHC10611-01KPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #23 97 MORRISVILLE PLAZA
PO BOX 979 		MORRISVILLEVT0566108/31/2012  
CHC10611-03KPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #23 97 MORRISVILLE PLAZA
PO BOX 979 		MORRISVILLEVT0566108/31/2012  
CHC10611-04KPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #23 97 MORRISVILLE PLAZA
PO BOX 979 		MORRISVILLEVT0566108/31/2012  
CHC10611-06KPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #23 97 MORRISVILLE PLAZA
PO BOX 979 		MORRISVILLEVT0566110/01/2020  
CHC10611-00KPH HEALTHCARE SERVICES, INC.KINNEY DRUGS #86 155 SOUTH MAIN STREET
PO BOX 1 		CAMBRIDGEVT0544404/01/2023  
CHC10611-00KPH HEALTHCARE SERVICES, INC.DBA: KINNEY DRUGS CF 471 E MAIN ST
UNIT 5 		GOUVERNEURNY1364210/01/2024  
CHC10611-03MARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 80 FAIRGROUNDS PLZ
MORRISVILLEVT0566110/01/2021  
CHC10611-01MARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 80 FAIRGROUNDS PLZ
MORRISVILLEVT0566110/01/2021  
CHC10611-04MARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 80 FAIRGROUNDS PLZ
MORRISVILLEVT0566110/01/2021  
CHC10611-06MARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 80 FAIRGROUNDS PLZ
MORRISVILLEVT0566110/01/2021  
CHC10611-00MARTIN'S FOODS OF SOUTH BURLINGTON, LLCDBA HANNAFORD SUPERMARKET & PHARMACY #81 80 FAIRGROUNDS PLZ
MORRISVILLEVT0566110/01/2021  
CHC10611-00MAXI GREEN, INC.RITE AID #10330 48 CONGRESS STREET
PO BOX 731 		MORRISVILLEVT0566111/02/2012 01/31/2018
CHC10611-00MAXI GREEN, INC.RITE AID #10336 82 ROUTE 15 WEST
HARDWICKVT0584311/02/2012 01/31/2018
CHC10611-01MAXI GREEN, INC.RITE AID #10330 48 CONGRESS STREET
PO BOX 731 		MORRISVILLEVT0566111/02/2012 01/31/2018
CHC10611-01MAXI GREEN, INC.RITE AID #10336 82 ROUTE 15 WEST
HARDWICKVT0584311/02/2012 01/31/2018
CHC10611-03MAXI GREEN, INC.RITE AID #10330 48 CONGRESS STREET
PO BOX 731 		MORRISVILLEVT0566111/02/2012 01/31/2018
CHC10611-03MAXI GREEN, INC.RITE AID #10336 82 ROUTE 15 WEST
HARDWICKVT0584311/02/2012 01/31/2018
CHC10611-04MAXI GREEN, INC.RITE AID #10330 48 CONGRESS STREET
PO BOX 731 		MORRISVILLEVT0566111/02/2012 01/31/2018
CHC10611-04MAXI GREEN, INC.RITE AID #10336 82 ROUTE 15 WEST
HARDWICKVT0584311/02/2012 01/31/2018
CHC10611-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255004/01/2024  
CHC10611-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
CHC10611-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024  
CHC10611-01SHAWS SUPERMARKETS INCSHAWS PHARMACY #0649 820 WATERBURY STOWE RD
WATERBURYVT0567601/01/2020  
CHC10611-03SHAWS SUPERMARKETS INCSHAWS PHARMACY #0649 820 WATERBURY STOWE RD
WATERBURYVT0567601/01/2020  
CHC10611-00SHAWS SUPERMARKETS INCSHAWS PHARMACY #0649 820 WATERBURY STOWE RD
WATERBURYVT0567601/01/2020  
CHC10611-04SHAWS SUPERMARKETS INCSHAWS PHARMACY #0649 820 WATERBURY STOWE RD
WATERBURYVT0567601/01/2020  
CHC10611-06SHAWS SUPERMARKETS INCSHAWS PHARMACY #0649 820 WATERBURY STOWE RD
WATERBURYVT0567610/01/2020  
CHC10611-00VERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10197 13 VT ROUTE 15 E
MORRISVILLEVT0566101/01/2017  
CHC10611-00VERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10127 1634 US ROUTE 302
BARREVT05641-232201/01/2021  
CHC10611-00VERMONT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01052 7 ESSEX WAY
ESSEXVT0545201/01/2021  
CHC10611-00VERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10216 69 MOUNTIAN VIEW DRIVE
COLCHESTERVT05446-591907/01/2021  
CHC10611-00VERMONT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 7103 49 WRIGHT AVE
WILLISTONVT05495-441907/01/2021  
CHC10611-00WALGREEN EASTERN CO., INC.WALGREENS #18977 48 CONGRESS ST
MORRISVILLEVT0566102/15/2018 03/21/2023
CHC10611-00WALGREEN EASTERN CO., INC.WALGREENS #17185 82 VT ROUTE 15 W
HARDWICKVT0584302/15/2018 09/30/2024
CHC10611-01WALGREEN EASTERN CO., INC.WALGREENS #18977 48 CONGRESS ST
MORRISVILLEVT0566102/15/2018 03/21/2023
CHC10611-01WALGREEN EASTERN CO., INC.WALGREENS #17185 82 VT ROUTE 15 W
HARDWICKVT0584302/15/2018  
CHC10611-03WALGREEN EASTERN CO., INC.WALGREENS #18977 48 CONGRESS ST
MORRISVILLEVT0566102/15/2018 03/21/2023
CHC10611-03WALGREEN EASTERN CO., INC.WALGREENS #17185 82 VT ROUTE 15 W
HARDWICKVT0584302/15/2018  
CHC10611-04WALGREEN EASTERN CO., INC.WALGREENS #18977 48 CONGRESS ST
MORRISVILLEVT0566102/15/2018 03/21/2023
CHC10611-04WALGREEN EASTERN CO., INC.WALGREENS #17185 82 VT ROUTE 15 W
HARDWICKVT0584302/15/2018  
CHC10611-06WALGREEN EASTERN CO., INC.WALGREENS #18977 48 CONGRESS ST
MORRISVILLEVT0566110/01/2020 03/21/2023
CHC10611-06WALGREEN EASTERN CO., INC.WALGREENS #17185 82 VT ROUTE 15 W
HARDWICKVT0584310/01/2020  
CHC10611-00WALGREEN EASTERN CO., INC.WALGREENS #17625 412 BROAD ST
LYNDONVILLEVT0585101/01/2025  
CHC10611-04Walgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204810/01/2023  
CHC10611-00Walgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204810/01/2023  
CHC10611-01Walgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204810/01/2023  
CHC10611-06Walgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204810/01/2023  
CHC10611-03Walgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204810/01/2023  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification1/30/2024 8:30:27 AM2/18/2025 12:14:15 PM2/18/2025 12:14 PM
ContactsAuthorizing OfficialUpdateAO Change RequestMay, Stuart G President / CEO Lamoille Health Partners 8028880901Bartlett, Susan Interim Chief Executive Officer Lamoille Health Partners 80288808952/18/2025 12:12 PM
DetailsLast Recertification DateUpdateRecertification2/14/2023 11:02:15 AM1/30/2024 8:30:27 AM1/30/2024 8:30 AM
DetailsLast Recertification DateUpdateRecertification2/1/2022 12:10:12 PM2/14/2023 11:02:15 AM2/14/2023 11:02 AM
AddressesShipping AddressInsertChange Request Lamoille Health Partners, Inc. DBA: Lamoille Health Pharmacy 1878 Mountain Road Stowe, VT 0567211/18/2022 6:44 AM
Medicaid BillingNPI: NumberInsertChange Request 11244363323/21/2022 2:14 PM
Medicaid BillingNPI: StateInsertChange Request VT3/21/2022 2:14 PM
Medicaid BillingNPI: NumberInsertChange Request 16391276813/21/2022 2:14 PM
Medicaid BillingNPI: StateInsertChange Request VT3/21/2022 2:14 PM
Medicaid BillingNPI: NumberInsertChange Request 17705415673/21/2022 2:14 PM
Medicaid BillingNPI: StateInsertChange Request VT3/21/2022 2:14 PM
Medicaid BillingNPI: NumberInsertChange Request 18513494843/21/2022 2:14 PM
Medicaid BillingNPI: StateInsertChange Request VT3/21/2022 2:14 PM
Medicaid BillingNPI: NumberInsertChange Request 18910137933/21/2022 2:14 PM
Medicaid BillingNPI: StateInsertChange Request VT3/21/2022 2:14 PM
Medicaid BillingNPI: NumberDeleteRecertification1770541567 (VT) 2/1/2022 12:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1639127681 (VT) 2/1/2022 12:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1124436332 (VT) 2/1/2022 12:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1851349484 (VT) 2/1/2022 12:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1134261076 (VT) 2/1/2022 12:10 PM
Medicaid BillingNPI: NumberDeleteRecertification1891013793 (VT) 2/1/2022 12:10 PM
DetailsLast Recertification DateUpdateRecertification2/3/2021 1:11:54 PM2/1/2022 12:10:12 PM2/1/2022 12:10 PM
AddressesBilling AddressInsertChange Request Lamoille Health Partners PO Box 749 Morrisville, VT 056617/14/2021 3:44 PM
DetailsEntity NameUpdateChange RequestCOPLEY PROFESSIONAL SERVICES GROUP DBA COMMUNITY HEALTH SERVICES OF LAMOILLE VALLEYLamoille Health Partners, Inc.6/14/2021 3:25 PM
ContactsPrimary ContactUpdateChange RequestLapan, Megan Corporate Compliance Officer Copley Professional Health Services 8028880903Lapan, Megan Corporate Compliance Officer & Risk Manager Lamoille Health Partners 80288809034/8/2021 10:35 AM
ContactsAuthorizing OfficialUpdateChange RequestMay, Stuart G President / CEO Community Health Services of Lamoille Valley 8028880901May, Stuart G President / CEO Lamoille Health Partners 80288809014/8/2021 10:35 AM
Medicaid BillingNPI: StateUpdateRecertification VT2/3/2021 1:11 PM
Medicaid BillingNPI: StateUpdateRecertification VT2/3/2021 1:11 PM
Medicaid BillingNPI: StateUpdateRecertification VT2/3/2021 1:11 PM
Medicaid BillingNPI: StateUpdateRecertification VT2/3/2021 1:11 PM
Medicaid BillingNPI: StateUpdateRecertification VT2/3/2021 1:11 PM
Medicaid BillingNPI: StateUpdateRecertification VT2/3/2021 1:11 PM
DetailsLast Recertification DateUpdateRecertification2/11/2020 1:01:42 PM2/3/2021 1:11:54 PM2/3/2021 1:11 PM
AddressesMain AddressUpdateChange Request 65 Northgate Plaza 11 MORRISVILLE, VT 05661 609 Washington Highway MORRISVILLE, VT 0566112/31/2020 6:40 AM
ContactsAuthorizing OfficialUpdateChange RequestMcCray, Scot President/CEO Copley Professional Health Services 8028880900May, Stuart G President / CEO Community Health Services of Lamoille Valley 802888090110/15/2020 1:20 PM
Medicaid BillingNPI: NumberInsertRecertification 18513494842/11/2020 1:01 PM
Medicaid BillingNPI: NumberInsertRecertification 11342610762/11/2020 1:01 PM
Medicaid BillingNPI: NumberInsertRecertification 18910137932/11/2020 1:01 PM
DetailsLast Recertification DateUpdateRecertification1/31/2019 10:46:48 AM2/11/2020 1:01:42 PM2/11/2020 1:01 PM
ContactsPrimary ContactUpdateChange RequestChauvin, Shannon Quality Improvement/Risk Management Specialist Copley Professional Health Services 8028880915Lapan, Megan Corporate Compliance Officer Copley Professional Health Services 80288809039/25/2019 12:09 PM
AddressesMain AddressUpdateChange Request 65 Northgate Plaza STE 11 MORRISVILLE, VT 05661 65 Northgate Plaza 11 MORRISVILLE, VT 056615/23/2019 7:14 AM
Medicaid BillingMedicaid: NumberDeleteChange Request1015558 (VT) 3/16/2019 4:01 PM
Medicaid BillingNPI: NumberUpdateChange Request131619596917705415673/16/2019 4:01 PM
Medicaid BillingNPI: NumberInsertChange Request 16391276813/16/2019 4:01 PM
Medicaid BillingNPI: NumberInsertChange Request 11244363323/16/2019 4:01 PM
AddressesMain AddressUpdateOPA Edit 65 Northgate Plaza Suite 11 MORRISVILLE, VT 05661 65 Northgate Plaza STE 11 MORRISVILLE, VT 056613/13/2019 7:22 AM
AddressesMain AddressUpdateChange Request 530 WASHINGTON HIGHWAY STE 12 MORRISVILLE, VT 05661 65 Northgate Plaza Suite 11 MORRISVILLE, VT 056613/13/2019 7:21 AM
Medicaid BillingNPI: NumberInsertChange Request 13161959693/13/2019 7:21 AM
DetailsLast Recertification DateUpdateRecertification2/14/2018 4:56:33 PM1/31/2019 10:46:48 AM1/31/2019 10:46 AM
ContactsPrimary ContactUpdateChange RequestZirena, Jose CFO Community Health Services of Lamoille Valley 8028518202Chauvin, Shannon Quality Improvement/Risk Management Specialist Copley Professional Health Services 80288809151/17/2019 1:30 PM
ContactsAuthorizing OfficialUpdateAO Change RequestKELLEY, KEVIN J. CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 8026884689McCray, Scot President/CEO Copley Professional Health Services 802888090011/30/2018 8:34 AM
ContactsPrimary ContactUpdateRecertificationKELLEY, KEVIN J. CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 8026884689Zirena, Jose CFO Community Health Services of Lamoille Valley 80285182022/14/2018 4:56 PM
DetailsLast Recertification DateUpdateRecertification2/1/2017 12:00:00 AM2/14/2018 4:56:33 PM2/14/2018 4:56 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestKELLEY, KEVIN CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 8026884689KELLEY, KEVIN J. CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 80268846892/14/2018 4:51 PM
ContactsPrimary ContactUpdateProfile Change RequestKELLEY, KEVIN CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 8026884689KELLEY, KEVIN J. CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 80268846892/14/2018 4:51 PM
ContactsAuthorizing OfficialUpdate KELLEY, KEVIN CEO 8026884689KELLEY, KEVIN CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 802688468911/28/2017 5:00 PM
ContactsPrimary ContactUpdate KELLEY, KEVIN CEO 8026884689KELLEY, KEVIN CEO Copley Professional Services Group, Inc. dba Community Health Services of Lamoille Valley 802688468911/28/2017 5:00 PM
AddressesMain AddressInsert   530 WASHINGTON HIGHWAY STE 12 MORRISVILLE, VT 056612/1/2017 11:43 AM
ContactsAuthorizing OfficialInsert  KELLEY, KEVIN CEO 80268846892/1/2017 11:43 AM
ContactsPrimary ContactInsert  KELLEY, KEVIN CEO 80268846892/1/2017 11:43 AM
DetailsLast Recertification DateUpdate 2/25/2016 12:00:00 AM2/1/2017 12:00:00 AM2/1/2017 11:43 AM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse2/25/2016 2:29 PM
DetailsLast Recertification DateUpdate 2/10/2015 12:00:00 AM2/25/2016 12:00:00 AM2/25/2016 2:29 PM
DetailsLast Recertification DateUpdate 3/11/2014 12:00:00 AM2/10/2015 12:00:00 AM2/10/2015 3:54 PM
DetailsLast Recertification DateUpdate 4/1/2013 12:00:00 AM3/11/2014 12:00:00 AM3/11/2014 5:08 PM
DetailsLast Recertification DateUpdate  4/1/2013 12:00:00 AM3/20/2013 1:05 PM
AddressesBilling AddressInsert  COMMUNITY HEALTH PHARMACY 158 BRENTWOOD DRIVE SUITE 7 COLCHESTER, VT 054466/8/2010 7:27 AM
DetailsLast Recertification DateInsert   6/8/2010 7:27 AM
DetailsGrant NumberInsert  H80CS106116/8/2010 7:27 AM
Details340B IDInsert  CHC10611-006/8/2010 7:27 AM
DetailsIs Authorizing Official EHB DataInsert   6/8/2010 7:27 AM
DatesLast Date That 340B Drugs PurchasedInsert   6/8/2010 7:27 AM
DetailsMedicare Provider NumberInsert   6/8/2010 7:27 AM
DetailsEntity NameInsert  COPLEY PROFESSIONAL SERVICES GROUP DBA COMMUNITY HEALTH SERVICES OF LAMOILLE VALLEY6/8/2010 7:27 AM
DetailsProgram CodeInsert  CH6/8/2010 7:27 AM
DetailsEntity SubnameInsert  ADMINISTRATIVE OFFICE6/8/2010 7:27 AM
DatesParticipating Approval DateInsert  3/11/2008 12:00:00 AM6/8/2010 7:27 AM
DetailsStateInsert  Active6/8/2010 7:27 AM
DatesRegistration DateInsert  6/7/2010 12:00:00 AM6/8/2010 7:27 AM
DatesSigned By DateInsert  2/14/2008 12:00:00 AM6/8/2010 7:27 AM
DatesStart DateInsert  4/1/2008 12:00:00 AM6/8/2010 7:27 AM
TerminationsTermination CommentsInsert   6/8/2010 7:27 AM
TerminationsTermination DateInsert   6/8/2010 7:27 AM
TerminationsTermination Effective DateInsert   6/8/2010 7:27 AM
TerminationsTermination ReasonInsert   6/8/2010 7:27 AM
Medicaid BillingMedicaid: Is PrimaryInsert  True6/7/2010 11:46 AM
Medicaid BillingMedicaid: NumberInsert  10155586/7/2010 11:46 AM
Medicaid BillingMedicaid: StateInsert  VT6/7/2010 11:46 AM