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DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
RRC470012-00 SOUTHWESTERN VERMONT MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHWESTERN VERMONT MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC470012-00
Entity Address
100 HOSPITAL DR
BENNINGTON, VT 05201
Medicare Provider Number
470012
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
Pharmacy Address
12 CENTERRA PKWY STE 10
LEBANON, NH 03766
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen D. Majetich, CFO
(802) 447-5011
Contract Pharmacy Representative
Dartmouth-Hitchcock Health
Linda M Sawyer, Sr Director Pharmacy Retail and Specialty Pharmacy
(603) 308-2282
Signed By Date
1/14/2019
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