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GAUTHIER'S PHARMACY
CAH471303-00 NORTHEASTERN VERMONT REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
NORTHEASTERN VERMONT REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471303-00
Entity Address
1315 HOSPITAL DRIVE
ST JOHNSBURY, VT 05819
Medicare Provider Number
471303
Participating Start Date
9/28/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
GAUTHIER'S PHARMACY
Pharmacy Address
415 RAILROAD STREET
ST. JOHNSBURY, VT 05819
Pharmacy Comments
Contract Details
Approval Date
7/13/2012
Contract Begin Date
7/13/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/14/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Robert Hersey, CFO
(802) 748-7530
Contract Pharmacy Representative
Carol Novick, Owner
(802) 748-3122
Signed By Date
6/21/2012
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