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SCH470005-00 RUTLAND REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
RUTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH470005-00
Medicare Provider Number
470005
Additional Details
Current Program Status
Terminated
Registration Date
9/30/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/30/2010
Last Recertification Date
8/24/2015
Termination Date
Termination Reason
7/1/2016
Change of covered entity type
Contacts
Authorizing Official
EDWARD OGORZALEK, CFO
(802) 747-1610
Primary Contact
Rutland Regional Medical Center
Jonathan Reynolds, VP Clinical Services
(802) 772-2634
Addresses
Street Address
160 ALLEN STREET
RUTLAND, VT 05701
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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09/30/10-DOC RECD TO CONFIRM ELIG DSH ADJ%
10/01/2010
April 2025
April 2025
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