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DSH470005P RUTLAND REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
RUTLAND REGIONAL MEDICAL CENTER
Subdivision Name
East Dorset Medical Campus / General Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH470005P
Medicare Provider Number
470005
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/17/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/25/2016
Last Recertification Date
8/28/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Rutland Regional Medical Center
Judi K Fox, CFO
(802) 747-1632
Primary Contact
Rutland Regional Medical Center
Jonathan Reynolds, VP Clinical Services
(802) 772-2634
Addresses
Street Address
51 Tennis Way
East Dorset, VT 05253
Billing Address
Rutland Regional Medical Center
160 Allen St
Rutland, VT 05701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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