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CAH471304-05 NORTH COUNTRY HEALTH SYSTEM (Terminated)
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Main Details
Name
NORTH COUNTRY HEALTH SYSTEM
Subdivision Name
Family Practice of Newport
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH471304-05
Medicare Provider Number
471304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/30/2012
Participating Start Date
10/1/2012
Participating Approval Date
8/20/2012
Last Recertification Date
8/11/2014
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
North Country Hospital
Tracey L. Paul, CFO
(802) 334-3271 Ext: 271
Primary Contact
North Country Hospital
Michael Omar, Director of Pharmacy
(802) 334-7331 Ext: 616
Addresses
Street Address
186 Medical Drive
Newport, VT 05855
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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