Contract Pharmacy Details

WAL-MART PHARMACY 10-5997
DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF VERMONT MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH470003

Entity Address

111 Colchester Avenue
Burlington, VT 05401

Medicare Provider Number

470003

Participating Start Date

4/1/2005

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-5997

Pharmacy Address

9600 PARKSOUTH CT. SUITE 100
ORLANDO, FL 32837

Pharmacy Comments

Contract Details

Approval Date

7/7/2020

Contract Begin Date

7/23/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Christina Oliver, VP of Clinical Services
(802) 847-2805

Contract Pharmacy Representative

Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498

Signed By Date

7/7/2020

340B Drug Pricing Program Database