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OPTUM FRONTIER THERAPIES II, LLC
SCH470001-00 Central Vermont Medical Center
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Covered Entity Details
Entity Name
Central Vermont Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH470001-00
Entity Address
130 FISHER ROAD
BERLIN, VT 05602
Medicare Provider Number
470001
Participating Start Date
9/30/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
OPTUM FRONTIER THERAPIES II, LLC
Pharmacy Address
6425 SANTA MARGARITA ST UNIT 110
LAS VEGAS, NV 89118-1913
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
7/21/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matthew Choate, Vice President Patient Care Services / CNO
(802) 371-4354
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
7/14/2020
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