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OPTUM PHARMACY 702, 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 PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
7/21/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Choate, Vice President Patient Care Services / CNO
(802) 371-4354
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
7/14/2020
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