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KPH HEALTHCARE SERVICES, INC.
DSH470003 UNIVERSITY OF VERMONT MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF VERMONT MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH470003
Entity Address
111 Colchester Avenue
Burlington, VT 05401
Medicare Provider Number
470003
Participating Start Date
4/1/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
KPH HEALTHCARE SERVICES, INC.
Pharmacy Address
KINNEY DRUGS #101
80 S MAIN STREET
WATERBURY, VT 05676-1553
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Oliver, VP of Clinical Services
(802) 847-2805
Contract Pharmacy Representative
KPH Health
ETHAN THOMAS, 340B COORDINATOR
(315) 287-3600
Signed By Date
10/16/2017
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