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CAH471301-02 GIFFORD MEDICAL CENTER (Terminated)
Main Details
Name
GIFFORD MEDICAL CENTER
Subdivision Name
BETHEL HEALTH CENTER
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH471301-02
Medicare Provider Number
471301
Outpatient Facility Provider Number
Contacts
Authorizing Official
Gifford Health Care
Daniel Bennett, CEO
(802) 728-2304
Primary Contact
Gifford
Rachel A DiStefano, Specialist
(802) 728-2203
Additional Details
Current Program Status
Terminated
Registration Date
6/7/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/14/2011
Last Recertification Date
8/21/2019
Termination Date
7/1/2020
Termination Reason
Change of covered entity type (non-hospital)
Addresses
Street Address
1823 VT RTE 107
RANDOLPH, VT 05032
Billing Address
GIFFORD MEDICAL CENTER
44 SOUTH MAIN STREET
RANDOLPH, VT 05060
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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