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PRICE CHOPPER OPER CO OF VT
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
PRICE CHOPPER OPER CO OF VT
Pharmacy Address
PRICE CHOPPER PHARMACY #192
90 CENTER ROAD
ESSEX JUNCTION, VT 05452
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
10/26/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Oliver, VP of Clinical Services
(802) 847-2805
Contract Pharmacy Representative
Golub Corporation
Scott Guisinger, Vice President of Pharmacy
(518) 379-2409
Signed By Date
10/4/2022
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