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CAH471307-09 Porter Hospital (Terminated)
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Main Details
Name
Porter Hospital
Subdivision Name
Porter Cardiology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH471307-09
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
8/21/2020
Termination Date
Termination Reason
7/1/2021
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Porter Medical Center
Michael Leyden, Associate Vice President - Operations
(802) 388-8855
Primary Contact
Porter Medical Center / Elizabethtown Community Hospital
Renee Mosier, Pharmacy Director
(802) 388-4701 Ext: 5624
Addresses
Street Address
115 Porter Drive
Middlebury, VT 05753
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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