Covered Entity Details

CAH471303-02 NORTHEASTERN VERMONT REGIONAL HOSPITAL (Active) - information as of 6/3/2025 12:02:21 PM

Main Details

Name

NORTHEASTERN VERMONT REGIONAL HOSPITAL

Subdivision Name

NVRH-ST. JOHNSBURY PEDIATRICS

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH471303-02

Medicare Provider Number

471303

Outpatient Facility Provider Number

473989

Additional Details

Current Program Status

Active

Registration Date

9/29/2010

Participating Start Date

1/1/2011

Participating Approval Date

12/21/2010

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

Northeastern Vermont Regional Hospital
Andre Leo Bissonnette, CFO
(802) 748-7520

Primary Contact

Northeastern Vermont Regional Hospital, Inc
Tracey L Herold, 340B Analyst
(802) 748-7583

Addresses

Street Address

97 SHERMAN DRIVE
ST. JOHNSBURY, VT 05819

Billing Address

NORTHEASTERN VERMONT REGIONAL HOSPITAL
1315 HOSPITAL DRIVE
ST JOHNSBURY, VT 05819

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?
No

Shipping Addresses

Shipping Address 1

Northeastern Vermont Regional Hospital
1315 Hospital Drive
St. Johnsbury, VT 05819

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
CAH471303-01	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH- CORNER MEDICAL	195 INDUSTRIAL PARKWAY	LYNDONVILLE	VT	Active
CAH471303-02	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH-ST. JOHNSBURY PEDIATRICS	97 SHERMAN DRIVE	ST. JOHNSBURY	VT	Active
CAH471303-03	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH-Surgical Group	1290 Hospital Drive	St Johnsbury	VT	Active
CAH471303-04	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH-Orthopedic Group	41 Sherman Drive	St Johnsbury	VT	Active
CAH471303-05	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH-Neurology Group	1290 Hospital Drive	St Johnsbury	VT	Active
CAH471303-06	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH-Womens Wellness Clinic	1315 Hospital Drive	St Johnsbury	VT	Active
CAH471303-07	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH-KINGDOM INTERNAL MEDICINE	714 BREEZY HILL ROAD	ST JOHNSBURY	VT	Active
CAH471303-08	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH Pulmonology Clinic - Pulmonology	1290 Hospital DR, LOWR LEVEL	ST JOHNSBURY	VT	Active
CAH471303-09	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH PODIATRY CLINIC - PODIATRY	1290 HOSPITAL DR	ST JOHNSBURY	VT	Active
CAH471303-10	Child	CAH	NORTHEASTERN VERMONT REGIONAL HOSPITAL	NVRH Pulmonology Group - Pulmonology	1290 Hospital Dr	St. Johnsbury	VT	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Change Request	NORTHEASTERN VERMONT REGIONAL HOSPITAL PO BOX 905 1315 HOSPITAL DRIVE ST JOHNSBURY, VT 05819-0905	NORTHEASTERN VERMONT REGIONAL HOSPITAL 1315 HOSPITAL DRIVE ST JOHNSBURY, VT 05819	9/26/2024 3:44 PM
Details	Last Recertification Date	Update	Recertification	8/17/2023 4:05:12 PM	8/21/2024 9:20:58 AM	8/21/2024 9:20 AM
Contacts	Primary Contact	Update	Group Change Request	Schoolcraft, Terri Controller NVRH 8027487508	Herold, Tracey L 340B Analyst Northeastern Vermont Regional Hospital, Inc 8027487583	8/23/2023 7:10 AM
Details	Last Recertification Date	Update	Recertification	9/6/2022 8:22:36 AM	8/17/2023 4:05:12 PM	8/17/2023 4:05 PM
Contacts	Authorizing Official	Update	AO Change Request	Hersey, Robert CFO NVRH 8027487520	Bissonnette, Andre Leo CFO Northeastern Vermont Regional Hospital 8027487520	5/30/2023 10:05 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 1:03:59 PM	9/6/2022 8:22:36 AM	9/6/2022 8:22 AM
Details	Last Recertification Date	Update	Recertification	8/21/2020 4:05:24 PM	8/23/2021 1:03:59 PM	8/23/2021 1:03 PM
Addresses	Billing Address	Update	Recertification	NORTHEASTERN VERMONT REGIONAL HOSPITAL PO BOX 905 ST JOHNSBURY, VT 05819-0905	NORTHEASTERN VERMONT REGIONAL HOSPITAL PO BOX 905 1315 HOSPITAL DRIVE ST JOHNSBURY, VT 05819-0905	8/21/2020 4:05 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 9:52:15 AM	8/21/2020 4:05:24 PM	8/21/2020 4:05 PM
Addresses	Shipping Address	Insert	Recertification		Northeastern Vermont Regional Hospital 1315 Hospital Drive St. Johnsbury, VT 05819	8/28/2019 9:52 AM
Details	Last Recertification Date	Update	Recertification	8/17/2018 9:51:18 AM	8/28/2019 9:52:15 AM	8/28/2019 9:52 AM
Details	Last Recertification Date	Update	Recertification	11/6/2017 5:41:11 PM	8/17/2018 9:51:18 AM	8/17/2018 9:51 AM
Details	Last Recertification Date	Update	Recertification	10/26/2017 2:15:24 PM	11/6/2017 5:41:11 PM	11/6/2017 5:41 PM
Contacts	Primary Contact	Insert	Recertification		Schoolcraft, Terri Controller NVRH 8027487508	10/26/2017 2:15 PM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	10/26/2017 2:15:24 PM	10/26/2017 2:15 PM
Contacts	Authorizing Official	Update		Hersey, Robert CFO 8027487520	Hersey, Robert CFO NVRH 8027487520	10/26/2017 11:49 AM
Contacts	Authorizing Official	Insert			Hersey, Robert CFO 8027487520	8/15/2016 1:55 PM
Addresses	Main Address	Insert			97 SHERMAN DRIVE ST. JOHNSBURY, VT 05819	8/15/2016 11:45 AM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/15/2016 11:45 AM
Details	Last Recertification Date	Update		8/28/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/19/2015 5:33 PM
Addresses	Billing Address	Insert			NORTHEASTERN VERMONT REGIONAL HOSPITAL PO BOX 905 ST JOHNSBURY, VT 05819-0905	12/11/2014 6:55 AM
Details	Last Recertification Date	Update		8/22/2013 10:55:42 AM	8/28/2014 12:00:00 AM	8/28/2014 10:54 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/22/2013 10:55:42 AM	8/22/2013 10:55 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	6/1/2012 7:49 AM
Details	Last Recertification Date	Insert				12/21/2010 5:41 PM
Details	Grant Number	Insert				12/21/2010 5:41 PM
Details	340B ID	Insert			CAH471303-02	12/21/2010 5:41 PM
Details	Is Authorizing Official EHB Data	Insert				12/21/2010 5:41 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/21/2010 5:41 PM
Details	Medicare Provider Number	Insert			471303	12/21/2010 5:41 PM
Details	Entity Name	Insert			NORTHEASTERN VERMONT REGIONAL HOSPITAL	12/21/2010 5:41 PM
Details	Program Code	Insert			CAH	12/21/2010 5:41 PM
Details	Entity Subname	Insert			NVRH-ST. JOHNSBURY PEDIATRICS	12/21/2010 5:41 PM
Dates	Participating Approval Date	Insert			12/21/2010 12:00:00 AM	12/21/2010 5:41 PM
Details	State	Insert			Active	12/21/2010 5:41 PM
Dates	Registration Date	Insert			9/29/2010 12:00:00 AM	12/21/2010 5:41 PM
Dates	Signed By Date	Insert			9/23/2010 12:00:00 AM	12/21/2010 5:41 PM
Dates	Start Date	Insert			1/1/2011 12:00:00 AM	12/21/2010 5:41 PM
Terminations	Termination Comments	Insert				12/21/2010 5:41 PM
Terminations	Termination Date	Insert				12/21/2010 5:41 PM
Terminations	Termination Effective Date	Insert				12/21/2010 5:41 PM
Terminations	Termination Reason	Insert				12/21/2010 5:41 PM