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CAH471301-18 GIFFORD MEDICAL CENTER (Terminated)
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Main Details
Name
GIFFORD MEDICAL CENTER
Subdivision Name
MENIG EXTENDED CARE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH471301-18
Medicare Provider Number
471301
Outpatient Facility Provider Number
475058
Additional Details
Current Program Status
Terminated
Registration Date
7/27/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/11/2011
Last Recertification Date
8/21/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Gifford Health Care
Daniel Bennett, CEO
(802) 728-2304
Primary Contact
Gifford
Rachel A DiStefano, Specialist
(802) 728-2203
Addresses
Street Address
44 SOUTH MAIN STREET
RANDOLPH, VT 05060
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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