Covered Entity Details

CAH471303-08 NORTHEASTERN VERMONT REGIONAL HOSPITAL (Active) - information as of 6/13/2025 2:57:47 PM

Main Details

Name

NORTHEASTERN VERMONT REGIONAL HOSPITAL

Subdivision Name

NVRH Pulmonology Clinic - Pulmonology

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH471303-08

Medicare Provider Number

471303

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/9/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/18/2024

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

1290 Hospital DR, LOWR LEVEL
ST JOHNSBURY, VT 05819

Billing Address

Northeastern Vermont Regional Hospital
PO Box 905
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
Contacts	Primary Contact	Update	PC Change Request	Hersey, Robert CFO NVRH 8027487530	Herold, Tracey L 340B Analyst Northeastern Vermont Regional Hospital, Inc 8027487583	9/27/2024 8:56 AM
Details	Last Recertification Date	Update	Recertification		8/21/2024 9:22:36 AM	8/21/2024 9:22 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Bissonnette, Andre Leo CFO Northeastern Vermont Regional Hospital 8027487520	1/18/2024 10:58 AM
Details	340B ID	Update	New Registration		CAH471303-08	1/18/2024 10:58 AM
Details	Entity Name	Update	New Registration	NORTHEASTERN VT REGIONAL HOPSITAL	NORTHEASTERN VERMONT REGIONAL HOSPITAL	1/18/2024 10:58 AM
Details	Entity Subname	Update	New Registration	NVRH Pulmonology Clinic	NVRH Pulmonology Clinic - Pulmonology	1/18/2024 10:58 AM
Dates	Participating Approval Date	Update	New Registration		1/18/2024 10:58:04 AM	1/18/2024 10:58 AM
Details	State	Update	New Registration	Pending	Approved	1/18/2024 10:58 AM
Dates	Signed By Date	Update	New Registration		1/10/2024 9:40:22 AM	1/18/2024 10:58 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/18/2024 10:58 AM
Addresses	Main Address	Insert	New Registration		1290 Hospital DR, LOWR LEVEL ST JOHNSBURY, VT 05819	1/9/2024 8:34 AM
Addresses	Billing Address	Insert	New Registration		Northeastern Vermont Regional Hospital PO Box 905 St Johnsbury, VT 05819	1/9/2024 8:34 AM
Addresses	Shipping Address	Insert	New Registration		Northeastern Vermont Regional Hospital 1315 Hospital Drive St Johnsbury, VT 05819	1/9/2024 8:34 AM
Contacts	Primary Contact	Insert	New Registration		Hersey, Robert CFO NVRH 8027487530	1/9/2024 8:34 AM
Contacts	Authorizing Official	Insert	New Registration		Bissonnette, Andre Leo CFO Northeastern Vermont Regional Hospital 8027487520	1/9/2024 8:34 AM
Details	Assistance Received From Date	Insert	New Registration			1/9/2024 8:34 AM
Details	Assistance Received To Date	Insert	New Registration			1/9/2024 8:34 AM
Details	Last Recertification Date	Insert	New Registration			1/9/2024 8:34 AM
Details	Grant Number	Insert	New Registration			1/9/2024 8:34 AM
Details	340B ID	Insert	New Registration			1/9/2024 8:34 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2024 8:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2024 8:34 AM
Details	Medicare Provider Number	Insert	New Registration		471303	1/9/2024 8:34 AM
Details	Entity Name	Insert	New Registration		NORTHEASTERN VT REGIONAL HOPSITAL	1/9/2024 8:34 AM
Details	NOFO Number	Insert	New Registration			1/9/2024 8:34 AM
Details	Program Code	Insert	New Registration		CAH	1/9/2024 8:34 AM
Details	Entity Subname	Insert	New Registration		NVRH Pulmonology Clinic	1/9/2024 8:34 AM
Dates	Participating Approval Date	Insert	New Registration			1/9/2024 8:34 AM
Details	State	Insert	New Registration		Pending	1/9/2024 8:34 AM
Dates	Registration Date	Insert	New Registration		1/9/2024 8:34:41 AM	1/9/2024 8:34 AM
Dates	Signed By Date	Insert	New Registration			1/9/2024 8:34 AM
Dates	Start Date	Insert	New Registration			1/9/2024 8:34 AM
Terminations	Termination Comments	Insert	New Registration			1/9/2024 8:34 AM
Terminations	Termination Date	Insert	New Registration			1/9/2024 8:34 AM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2024 8:34 AM
Terminations	Termination Reason	Insert	New Registration			1/9/2024 8:34 AM