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MONTPELIER PHARMACY
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
MONTPELIER PHARMACY
Pharmacy Address
69 MAIN STREET
MONTPELIER, VT 05602
Pharmacy Comments
Contract Details
Approval Date
10/18/2012
Contract Begin Date
10/18/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2017
Ownership change
Contacts
Covered Entity Signing Official
Roger Deshaies, CFO
(802) 847-9975
Contract Pharmacy Representative
Sarah Harvie, Bookkeeper
(802) 223-4633
Signed By Date
8/28/2012
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