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VERMONT CVS PHARMACY, L.L.C.
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
VERMONT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00673
31 S MAIN ST
RUTLAND, VT 05701-5041
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen D. Majetich, CFO
(802) 447-5011
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2020
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