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CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED
CAH331302-00 ELIZABETHTOWN COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
ELIZABETHTOWN COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH331302-00
Entity Address
75 PARK STREET
ELIZABETHTOWN, NY 12932
Medicare Provider Number
331302
Participating Start Date
9/30/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED
Pharmacy Address
THE UNIVERSITY OF VERMONT HEALTH NETWORK
75 BEEKMAN ST
PLATTSBURGH, NY 12901-1438
Pharmacy Comments
Contract Details
Approval Date
4/16/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Alan Comeau, CFO
(802) 388-4752
Contract Pharmacy Representative
Alice Hyde Medical Center/Champlain Valley Physicians Hospital
Matej Kollar, Vice President/Chief Financial Officer
(518) 481-8065
Signed By Date
4/16/2025
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