Covered Entity Details

DSH470003T UNIVERSITY OF VERMONT MEDICAL CENTER (Active) - information as of 5/14/2025 10:56:41 PM

Main Details

Name

UNIVERSITY OF VERMONT MEDICAL CENTER

Subdivision Name

Adult Primary Care - South Burlington

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH470003T

Medicare Provider Number

470003

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/3/2013

Participating Start Date

4/1/2013

Participating Approval Date

1/16/2013

Last Recertification Date

8/27/2024

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

1 Timber Lane
South Burlington, VT 05403-7205

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
Contacts	Primary Contact	Update	Profile Change Request	Beric, Minela Manager, Network 340B & Pharmacy Ops UNIVERSITY OF VERMONT MEDICAL CENTER 8028477567	Beric, Minela Manager, Network 340B & Pharmacy Ops UNIVERSITY OF VERMONT MEDICAL CENTER 8025423455	9/24/2024 4:16 PM
Addresses	Shipping Address	Delete	Recertification	University of Vermont Medical Center Main Campus 111 Colchester ave Burlington, VT 05401		8/27/2024 7:40 AM
Addresses	Shipping Address	Insert	Recertification		University of Vermont Medical Center Main Campus 111 Colchester Avenue Burlington, VT 05401	8/27/2024 7:40 AM
Addresses	Main Address	Update	Recertification	1 Timber Lane South Burlington, VT 05403	1 Timber Lane South Burlington, VT 05403-7205	8/27/2024 7:40 AM
Details	Last Recertification Date	Update	Recertification	9/5/2023 11:41:45 AM	8/27/2024 7:40:04 AM	8/27/2024 7:40 AM
Contacts	Primary Contact	Update	PC Change Request	Bergeron, Gary Paul Pharmacy Supervisor University of Vermont Medical Center 8028473962	Beric, Minela Manager, Network 340B & Pharmacy Ops UNIVERSITY OF VERMONT MEDICAL CENTER 8028477567	12/13/2023 3:49 PM
Contacts	Authorizing Official	Update	AO Change Request	Oliver, Christina VP of Clinical Services University of Vermont Medical Center 8028472805	McMillian, Wesley Network Vice President of Pharmacy University of Vermont Medical Center, Inc 8028473546	11/1/2023 10:23 AM
Details	Last Recertification Date	Update	Recertification	9/8/2022 8:53:01 AM	9/5/2023 11:41:45 AM	9/5/2023 11:41 AM
Details	Last Recertification Date	Update	Recertification	8/25/2021 8:57:35 AM	9/8/2022 8:53:01 AM	9/8/2022 8:53 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 9:44:55 AM	8/25/2021 8:57:35 AM	8/25/2021 8:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1568419976	9/9/2020 9:44 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/9/2020 9:44 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1659309615	9/9/2020 9:44 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/9/2020 9:44 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1659309615 ( )		9/9/2020 9:44 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1568419976 ( )		9/9/2020 9:44 AM
Details	Last Recertification Date	Update	Recertification	8/29/2019 1:19:54 PM	9/9/2020 9:44:55 AM	9/9/2020 9:44 AM
Addresses	Billing Address	Insert	Change Request		UNIVERSITY OF VERMONT MEDICAL CENTER PO Box 1870 111 Colchester Avenue Burlington, VT 05402	10/30/2019 3:48 PM
Details	Last Recertification Date	Update	Recertification	8/16/2018 11:17:47 AM	8/29/2019 1:19:54 PM	8/29/2019 1:19 PM
Details	Entity Subname	Update	Change Request	Adult Primary Care- South Burlington	Adult Primary Care - South Burlington	5/9/2019 3:25 PM
Contacts	Primary Contact	Update	Profile Change Request	Bergeron, Gary Paul Pharamcy Supervisor UVMMC 8028473962	Bergeron, Gary Paul Pharmacy Supervisor University of Vermont Medical Center 8028473962	5/8/2019 10:25 AM
Details	Last Recertification Date	Update	Recertification	11/21/2017 9:15:48 AM	8/16/2018 11:17:47 AM	8/16/2018 11:17 AM
Contacts	Primary Contact	Update	Profile Change Request	Bergeron, Gary paul Pharamcy Supervisor UVMMC 8028473962	Bergeron, Gary Paul Pharamcy Supervisor UVMMC 8028473962	6/28/2018 10:22 AM
Addresses	Shipping Address	Insert	Change Request		University of Vermont Medical Center Main Campus 111 Colchester ave Burlington, VT 05401	5/9/2018 3:25 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1568419976	2/14/2018 1:25 PM
Contacts	Primary Contact	Update	Recertification	Bergeron, Gary Pharamcy Supervisor UVMMC 8028473962	Bergeron, Gary paul Pharamcy Supervisor UVMMC 8028473962	11/21/2017 9:59 AM
Medicaid Billing	Medicaid: Number	Update	Recertification	OVN0997	0VN0997	11/21/2017 9:15 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1659309615	11/21/2017 9:15 AM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	11/21/2017 9:15:48 AM	11/21/2017 9:15 AM
Contacts	Primary Contact	Update		Bergeron, Gary Pharamcy Supervisor 8028473962	Bergeron, Gary Pharamcy Supervisor UVMMC 8028473962	10/10/2017 3:17 PM
Contacts	Authorizing Official	Update		Oliver, Christina VP of Clinical Services 8028472805	Oliver, Christina VP of Clinical Services University of Vermont Medical Center 8028472805	10/9/2017 2:57 PM
Contacts	Primary Contact	Update		MCBRIDE, KAREN DIRECTOR, PHARMACY SERVICES 8028473546	Bergeron, Gary Pharamcy Supervisor 8028473962	8/3/2017 10:40 AM
Contacts	Signed By	Insert			Deshaies, Roger CFO 8028479975	8/3/2017 10:40 AM
Contacts	Authorizing Official	Update		Felis, Sandra COO/CNO 8028470171	Oliver, Christina VP of Clinical Services 8028472805	8/3/2017 10:40 AM
Addresses	Main Address	Insert			1 Timber Lane South Burlington, VT 05403	5/15/2017 4:25 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 8:41 AM
Contacts	Primary Contact	Insert			MCBRIDE, KAREN DIRECTOR, PHARMACY SERVICES 8028473546	4/6/2016 12:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/19/2015 9:30 AM
Medicaid Billing	Medicaid: Number	Insert			470003	8/19/2015 9:30 AM
Medicaid Billing	Medicaid: State	Insert			VT	8/19/2015 9:30 AM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/19/2015 12:00:00 AM	8/19/2015 9:30 AM
Details	Entity Subname	Update		Primary Care Internal Medicine, Aesculapius	Adult Primary Care- South Burlington	3/26/2015 11:59 AM
Contacts	Authorizing Official	Update		Holder, Sophia G. Interim CFO 8028478078	Felis, Sandra COO/CNO 8028470171	11/20/2014 9:52 AM
Details	Entity Name	Update		FLETCHER ALLEN HEALTH CARE	UNIVERSITY OF VERMONT MEDICAL CENTER	11/13/2014 2:12 PM
Details	Last Recertification Date	Update		9/3/2013 8:52:06 AM	9/3/2014 12:00:00 AM	9/3/2014 9:22 PM
Contacts	Authorizing Official	Insert			Holder, Sophia G. Interim CFO 8028478078	3/31/2014 11:46 AM
Details	Last Recertification Date	Update			9/3/2013 8:52:06 AM	9/3/2013 8:52 AM
Details	340B ID	Update		ISDR-DSH470003T	DSH470003T	1/16/2013 11:10 AM
Details	Entity Subname	Update		PCIM, Aesculapius	Primary Care Internal Medicine, Aesculapius	1/16/2013 11:10 AM
Dates	Participating Approval Date	Update			1/16/2013 12:00:00 AM	1/16/2013 11:10 AM
Details	State	Update		Pending	Active	1/16/2013 11:10 AM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	1/16/2013 11:10 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISDR-DSH470003T	1/14/2013 3:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/3/2013 1:45 PM
Medicaid Billing	Medicaid: Number	Insert			OVN0997	1/3/2013 1:45 PM
Medicaid Billing	Medicaid: State	Insert			VT	1/3/2013 1:45 PM
Details	Last Recertification Date	Insert				1/3/2013 1:45 PM
Details	Grant Number	Insert				1/3/2013 1:45 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/3/2013 1:45 PM
Details	Is Authorizing Official EHB Data	Insert				1/3/2013 1:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/3/2013 1:45 PM
Details	Medicare Provider Number	Insert			470003	1/3/2013 1:45 PM
Details	Entity Name	Insert			FLETCHER ALLEN HEALTH CARE	1/3/2013 1:45 PM
Details	Program Code	Insert			DSH	1/3/2013 1:45 PM
Details	Entity Subname	Insert			PCIM, Aesculapius	1/3/2013 1:45 PM
Dates	Participating Approval Date	Insert				1/3/2013 1:45 PM
Details	State	Insert			Pending	1/3/2013 1:45 PM
Dates	Registration Date	Insert			1/3/2013 12:00:00 AM	1/3/2013 1:45 PM
Dates	Signed By Date	Insert			1/3/2013 12:00:00 AM	1/3/2013 1:45 PM
Dates	Start Date	Insert				1/3/2013 1:45 PM
Terminations	Termination Comments	Insert				1/3/2013 1:45 PM
Terminations	Termination Date	Insert				1/3/2013 1:45 PM
Terminations	Termination Effective Date	Insert				1/3/2013 1:45 PM
Terminations	Termination Reason	Insert				1/3/2013 1:45 PM