Covered Entity Details

SCH470001-22 Central Vermont Medical Center (Active) - information as of 5/3/2025 11:27:34 PM

Main Details

Name

Central Vermont Medical Center

Subdivision Name

Express Care

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH470001-22

Medicare Provider Number

470001

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/6/2015

Participating Start Date

7/1/2015

Participating Approval Date

5/26/2015

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Central Vermont Medical Center
Matthew Choate, Vice President Patient Care Services / CNO
(802) 371-4354

Primary Contact

Central Vermont Medical Center
Emily Walsh, Director of Pharmacy
(802) 225-3920

Addresses

Street Address

1311 Barre Montpelier Road Suite 200
Berlin, VT 05641

Billing Address

Central Vermont Medical Center
P.O. Box 547
Barre, VT 05641

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		1508845637,1023028784

Shipping Addresses

Shipping Address 1

Central Vermont Medical Center
130 Fisher Road
Berlin, VT 05602

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
SCH470001-02	Child	SCH	Central Vermont Medical Center	Integrative Family Medicine Montpelier	156 MAIN STREET	MONTPELIER	VT	Active
SCH470001-03	Child	SCH	Central Vermont Medical Center	Family Medicine Mad River	859 OLD COUNTY ROAD	WAITSFIELD	VT	Active
SCH470001-04	Child	SCH	Central Vermont Medical Center	Pediatrics Primary Care-Berlin	246 GRANGER RD	BERLIN	VT	Active
SCH470001-05	Child	SCH	Central Vermont Medical Center	Urology	130 Fisher Road	BERLIN	VT	Active
SCH470001-06	Child	SCH	Central Vermont Medical Center	Adult Primary Care, Hematology and Oncology-Berlin	130 Fisher Road	BERLIN	VT	Active
SCH470001-07	Child	SCH	Central Vermont Medical Center	Adult Primary Care-Barre	225 SOUTH MAIN STREET	BARRE	VT	Active
SCH470001-08	Child	SCH	Central Vermont Medical Center	Rheumatology	130 Fisher Road	BERLIN	VT	Active
SCH470001-09	Child	SCH	Central Vermont Medical Center	Family Medicine Waterbury	130 SOUTH MAIN STREET	WATERBURY	VT	Active
SCH470001-11	Child	SCH	Central Vermont Medical Center	UVMHN-CVMC Obstetrics, Midwifery and Gynecology	130 FISHER RD	BERLIN	VT	Active
SCH470001-12	Child	SCH	Central Vermont Medical Center	Family Medicine-Berlin	246 GRANGER RD	Berlin	VT	Active
SCH470001-13	Child	SCH	Central Vermont Medical Center	Green Mountain Family Practice	87 Paine Mountain Drive	NORTHFIELD	VT	Active
SCH470001-14	Child	SCH	Central Vermont Medical Center	Cardiology	130 FISHER RD	BERLIN	VT	Active
SCH470001-15	Child	SCH	Central Vermont Medical Center	Pediatrics Primary Care-Barre	225 SOUTH MAIN STREET	BARRE	VT	Terminated
SCH470001-16	Child	SCH	Central Vermont Medical Center	Neurology	130 FISHER RD	BERLIN	VT	Active
SCH470001-17	Child	SCH	Central Vermont Medical Center	CVMC Family Psychiatry	82 East View Lane	Berlin	VT	Terminated
SCH470001-18	Child	SCH	Central Vermont Medical Center	Endocrinology	130 Fisher Road	Berlin	VT	Active
SCH470001-19	Child	SCH	Central Vermont Medical Center	Orthopedics and Spine Medicine	1311 Barre-Montpelier Road	Berlin	VT	Active
SCH470001-20	Child	SCH	Central Vermont Medical Center	Orthopedics and Sports Medicine	1311 Barre-Montpelier Road	Berlin	VT	Active
SCH470001-21	Child	SCH	Central Vermont Medical Center	Orthopedics and Podiatry	1311 Barre-Montpelier Road	Berlin	VT	Active
SCH470001-22	Child	SCH	Central Vermont Medical Center	Express Care	1311 Barre Montpelier Road Suite 200	Berlin	VT	Active
SCH470001-23	Child	SCH	Central Vermont Medical Center	GRANITE CITY PRIMARY CARE	14 NORTH MAIN STREET, SUITE 4002	BARRE	VT	Terminated
SCH470001-24	Child	SCH	Central Vermont Medical Center	Waterbury Express Care	76 MCNEIL RD, SUITE 2	WATERBURY CENTER	VT	Terminated
SCH470001-25	Child	SCH	Central Vermont Medical Center	CVMC Infectious Disease	130 Fisher Road	Berlin	VT	Active
SCH470001-26	Child	SCH	Central Vermont Medical Center	Dermatology	130 Fisher Road	Berlin	VT	Active
SCH470001-27	Child	SCH	Central Vermont Medical Center	CENTRAL VERMONT MEDICAL CENTER INC - PULMONOLOGY	CVMC PULMONOLOGY	BERLIN	VT	Active
SCH470001-28	Child	SCH	Central Vermont Medical Center	CENTRAL VERMONT MEDICAL CENTER - FAMILY MEDICINE	CVMC FAMILY MEDICINE-MAIN CAMPUS	BERLIN	VT	Active
SCH470001-29	Child	SCH	Central Vermont Medical Center	CENTRAL VERMONT MEDICAL CENTER - GENERAL SURGERY	CVMC GENERAL SURGERY	BERLIN	VT	Active
SCH470001-30	Child	SCH	Central Vermont Medical Center	CENTRAL VERMONT MEDICAL CENTER - ENT	CVMC ENT	BERLIN	VT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 1:50:53 PM	8/15/2024 1:10:34 PM	8/15/2024 1:10 PM
Contacts	Primary Contact	Update	Profile Change Request	Prescott, Emily Director of Pharmacy Central Vermont Medical Center 8022253920	Walsh, Emily Director of Pharmacy Central Vermont Medical Center 8022253920	1/29/2024 1:14 PM
Details	Last Recertification Date	Update	Recertification	9/15/2022 2:21:58 PM	8/22/2023 1:50:53 PM	8/22/2023 1:50 PM
Details	Last Recertification Date	Update	Recertification	9/10/2021 6:28:23 PM	9/15/2022 2:21:58 PM	9/15/2022 2:21 PM
Contacts	Primary Contact	Update	Profile Change Request	Prescott, Emily Interim Director of Pharmacy Central Vermont Medical Center 8022253920	Prescott, Emily Director of Pharmacy Central Vermont Medical Center 8022253920	8/18/2022 2:28 PM
Contacts	Primary Contact	Update	Recertification	Foti, Frank Director of Pharmacy Central Vermont Medical Center 8023715938	Prescott, Emily Interim Director of Pharmacy Central Vermont Medical Center 8022253920	9/10/2021 6:28 PM
Details	Last Recertification Date	Update	Recertification	9/11/2020 2:14:07 PM	9/10/2021 6:28:23 PM	9/10/2021 6:28 PM
Medicaid Billing	NPI: State	Update	Recertification		VT	9/11/2020 2:14 PM
Medicaid Billing	NPI: State	Update	Recertification		VT	9/11/2020 2:14 PM
Details	Last Recertification Date	Update	Recertification	9/13/2019 6:51:35 AM	9/11/2020 2:14:07 PM	9/11/2020 2:14 PM
Addresses	Main Address	Update	Recertification	1311 Barre Montpelier Road Suite 200 Berlin, VT 05602	1311 Barre Montpelier Road Suite 200 Berlin, VT 05641	9/13/2019 6:51 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 10:22:10 AM	9/13/2019 6:51:35 AM	9/13/2019 6:51 AM
Contacts	Primary Contact	Update	Change Request	Walsh, Joseph 340B analyst Central Vermont Medical Center 8022253925	Foti, Frank Director of Pharmacy Central Vermont Medical Center 8023715938	11/5/2018 11:40 AM
Details	Last Recertification Date	Update	Recertification	12/4/2017 4:05:51 PM	9/5/2018 10:22:10 AM	9/5/2018 10:22 AM
Contacts	Authorizing Official	Update	Change Request	Holland, Cheyenne CFO Central Vermont Medical Center 8023714443	Choate, Matthew Vice President Patient Care Services / CNO Central Vermont Medical Center 8023714354	8/3/2018 10:15 AM
Contacts	Primary Contact	Update	Change Request	Foti, Frank Director of Pharmacy Central Vermont Medical Center 8023715938	Walsh, Joseph 340B analyst Central Vermont Medical Center 8022253925	7/17/2018 11:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1023028784	2/15/2018 8:56 AM
Details	Last Recertification Date	Update	Recertification	9/2/2016 12:00:00 AM	12/4/2017 4:05:51 PM	12/4/2017 4:05 PM
Contacts	Primary Contact	Update	Change Request	Gibbs, Amy Director of Finance 8022257531	Foti, Frank Director of Pharmacy Central Vermont Medical Center 8023715938	10/4/2017 10:40 AM
Contacts	Authorizing Official	Update		Holland, Cheyenne CFO 8023714443	Holland, Cheyenne CFO Central Vermont Medical Center 8023714443	10/4/2017 9:49 AM
Contacts	Signed By	Update		Holland, Cheyenne CFO 8023714443	Holland, Cheyenne CFO Central Vermont Medical Center 8023714443	10/4/2017 9:49 AM
Addresses	Main Address	Insert			1311 Barre Montpelier Road Suite 200 Berlin, VT 05602	5/3/2017 2:08 PM
Addresses	Billing Address	Insert			Central Vermont Medical Center P.O. Box 547 Barre, VT 05641	5/3/2017 2:08 PM
Addresses	Shipping Address	Insert			Central Vermont Medical Center 130 Fisher Road Berlin, VT 05602	5/3/2017 2:08 PM
Contacts	Primary Contact	Insert			Gibbs, Amy Director of Finance 8022257531	5/3/2017 2:08 PM
Contacts	Authorizing Official	Insert			Holland, Cheyenne CFO 8023714443	5/3/2017 2:08 PM
Contacts	Signed By	Insert			Holland, Cheyenne CFO 8023714443	5/3/2017 2:08 PM
Details	Last Recertification Date	Update		8/13/2015 12:00:00 AM	9/2/2016 12:00:00 AM	9/2/2016 10:11 AM
Details	Last Recertification Date	Update			8/13/2015 12:00:00 AM	8/13/2015 9:40 AM
Details	Entity Name	Update		CENTRAL VERMONT HOSPITAL	Central Vermont Medical Center	6/12/2015 1:44 PM
Details	Entity Subname	Update		CVMC Express Care	Express Care	6/12/2015 1:44 PM
Dates	Participating Approval Date	Update			5/26/2015 12:00:00 AM	5/26/2015 10:19 AM
Details	State	Update		Pending	Active	5/26/2015 10:19 AM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	5/26/2015 10:19 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_50683	SCH470001-22	4/24/2015 9:05 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_50683	4/6/2015 3:12 PM
Medicaid Billing	NPI: Number	Insert			1508845637	4/6/2015 3:12 PM
Details	Last Recertification Date	Insert				4/6/2015 3:12 PM
Details	Grant Number	Insert				4/6/2015 3:12 PM
Details	340B ID	Insert				4/6/2015 3:12 PM
Details	Is Authorizing Official EHB Data	Insert				4/6/2015 3:12 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/6/2015 3:12 PM
Details	Medicare Provider Number	Insert			470001	4/6/2015 3:12 PM
Details	Entity Name	Insert			CENTRAL VERMONT HOSPITAL	4/6/2015 3:12 PM
Details	Program Code	Insert			SCH	4/6/2015 3:12 PM
Details	Entity Subname	Insert			CVMC Express Care	4/6/2015 3:12 PM
Dates	Participating Approval Date	Insert				4/6/2015 3:12 PM
Details	State	Insert			Pending	4/6/2015 3:12 PM
Dates	Registration Date	Insert			4/6/2015 12:00:00 AM	4/6/2015 3:12 PM
Dates	Signed By Date	Insert			4/6/2015 12:00:00 AM	4/6/2015 3:12 PM
Dates	Start Date	Insert				4/6/2015 3:12 PM
Terminations	Termination Comments	Insert				4/6/2015 3:12 PM
Terminations	Termination Date	Insert				4/6/2015 3:12 PM
Terminations	Termination Effective Date	Insert				4/6/2015 3:12 PM
Terminations	Termination Reason	Insert				4/6/2015 3:12 PM