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HIGH MOUNTAIN CORPORATION
DSH470005 RUTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RUTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH470005
Entity Address
160 ALLEN STREET
RUTLAND, VT 05701
Medicare Provider Number
470005
Participating Start Date
7/1/2016
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
HIGH MOUNTAIN CORPORATION
Pharmacy Address
DBA RUTLAND PHARMACY
75 ALLEN ST
RUTLAND, VT 05701-4501
Pharmacy Comments
06/13/2013-Pharmacy name and address changed in error on 3/28/2013
Contract Details
Approval Date
5/2/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EDWARD OGORZALEK, CFO
(802) 747-1610
Contract Pharmacy Representative
Signed By Date
5/2/2016
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