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LYNNFIELD DRUG INC
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
LYNNFIELD DRUG INC
Pharmacy Address
DBA FREEDOM FERTILITY PHARMACY
374 MERRIMAC ST STE 100
NEWBURYPORT, MA 01950
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Oliver, VP of Clinical Services
(802) 847-2805
Contract Pharmacy Representative
Lynfield Drug, Inc.
Hilary Thibault, Pharmacist in Charge
(800) 660-4283 Ext: 271916
Signed By Date
4/14/2017
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