Contract Pharmacy Details

VERMONT CVS PHARMACY, L.L.C.
DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER

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 #10216
69 MOUNTIAN VIEW DRIVE
COLCHESTER, VT 05446-5919

Pharmacy Comments

Contract Details

Approval Date

10/6/2016

Contract Begin Date

1/1/2017

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

10/6/2016

340B Drug Pricing Program Database