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NOBLE HEALTH SERVICES INC.
SCH470001-00 Central Vermont Medical Center
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Covered Entity Details
Entity Name
Central Vermont Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH470001-00
Entity Address
130 FISHER ROAD
BERLIN, VT 05602
Medicare Provider Number
470001
Participating Start Date
9/30/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES INC.
Pharmacy Address
6040 TARBELL ROAD
SYRACUSE, NY 13206
Pharmacy Comments
Contract Details
Approval Date
7/2/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheyenne Holland, CFO
(802) 371-4443
Contract Pharmacy Representative
Debbi Barber, Director of PBM Relations
(315) 287-3600 Ext: 2423
Signed By Date
7/2/2015
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