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CAH471307-01 PORTER HOSPITAL (Terminated)
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Main Details
Name
PORTER HOSPITAL
Subdivision Name
Porter Internal Medicine
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH471307-01
Medicare Provider Number
471307
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/27/2012
Participating Start Date
7/1/2012
Participating Approval Date
5/23/2012
Last Recertification Date
8/6/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
UVMHN-Porter Medical Center
Karen Beinhaur, CNO
(802) 388-5637
Primary Contact
Porter Medical Center / Elizabethtown Community Hospital
Renee Mosier, Pharmacy Director
(802) 388-4701 Ext: 5624
Addresses
Street Address
116 Porter Drive
Middlebury, VT 05753
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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