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MARBLE WORKS 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
MARBLE WORKS PHARMACY
Pharmacy Address
PHARMACY HEALTH SERVICES
99 MAPLE STREET
MIDDLEBURY, VT 05753
Pharmacy Comments
Contract Details
Approval Date
10/24/2012
Contract Begin Date
10/24/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Ownership change
Contacts
Covered Entity Signing Official
Roger Deshaies, CFO
(802) 847-9975
Contract Pharmacy Representative
Diane Gray, General Manager
(802) 453-2999
Signed By Date
9/28/2012
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