Contract Pharmacy Details

CORAM HEALTHCARE CORPORATION OF GREATER
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

CORAM HEALTHCARE CORPORATION OF GREATER

Pharmacy Address

DBA CORAM CVS/SPECIALTY INFUSION SERVICE
12 JUPITER LANE
ALBANY, NY 12205-6918

Pharmacy Comments

Contract Details

Approval Date

4/14/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/4/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Christina Oliver, VP of Clinical Services
(802) 847-2805

Contract Pharmacy Representative

Debbie O'Brien, Pharmacy Manager
(518) 689-2950

Signed By Date

4/14/2017

340B Drug Pricing Program Database