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VERMONT CVS PHARMACY, L.L.C.
RRC470012-00 SOUTHWESTERN VERMONT MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHWESTERN VERMONT MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC470012-00
Entity Address
100 HOSPITAL DR
BENNINGTON, VT 05201
Medicare Provider Number
470012
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
VERMONT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00337
8 KOCHER DR.
BENNINGTON, VT 05201
Pharmacy Comments
Contract Details
Approval Date
1/13/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen D. Majetich, CFO
(802) 447-5011
Contract Pharmacy Representative
CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467
Signed By Date
1/13/2016
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