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CAH471301-03 GIFFORD MEDICAL CENTER (Terminated)
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Main Details
Name
GIFFORD MEDICAL CENTER
Subdivision Name
KINGWOOD HEALTH CENTER - NEURO CLINIC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH471301-03
Medicare Provider Number
471301
Outpatient Facility Provider Number
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
9/19/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Gifford Health Care
Daniel Bennett, CEO
(802) 728-2304
Primary Contact
Gifford Health Care, Inc.
Dawn M Cogger, 340B Coordinator
(802) 728-2108
Addresses
Street Address
1422 ROUTE 66
RANDOLPH, VT 05060
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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