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UNIVERSITY OF VERMONT MEDICAL CENTER
DSH330250 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
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Covered Entity Details
Entity Name
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH330250
Entity Address
75 BEEKMAN STREET
PLATTSBURGH, NY 12901
Medicare Provider Number
330250
Participating Start Date
6/3/2019
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY OF VERMONT MEDICAL CENTER
Pharmacy Address
OUTPATIENT PHARMACY
1 S PROSPECT ST
BURLINGTON, VT 05401-3456
Pharmacy Comments
Contract Details
Approval Date
5/31/2019
Contract Begin Date
6/3/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michelle M LeBeau, President/Chief Operations officer
(518) 562-7055
Contract Pharmacy Representative
University of Vermont Medical Center
Nathan M Awrich, System VP, Pharmacy Operations
(802) 847-3605
Signed By Date
4/14/2019
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