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VERMONT CVS PHARMACY, L.L.C.
DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER
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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
VERMONT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 10197
13 VT ROUTE 15 E
MORRISVILLE, VT 05661
Pharmacy Comments
Contract Details
Approval Date
10/6/2020
Contract Begin Date
10/14/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Oliver, VP of Clinical Services
(802) 847-2805
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/6/2020
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