Covered Entity Details

RRC300012-10 ELLIOT HOSPITAL (Active) - information as of 4/23/2025 10:53:24 PM

Main Details

Name

ELLIOT HOSPITAL

Subdivision Name

ELLIOT MEDICATION CLINIC- RAYMOND - CC

Type

Rural Referral Center

Rural

340B ID

RRC300012-10

Medicare Provider Number

300012

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2024

Participating Start Date

10/1/2024

Participating Approval Date

8/29/2024

Last Recertification Date

Contacts

Authorizing Official

Elliot Hospital
Joseph Tate Curti, COO
(603) 663-2082

Primary Contact

Elliot Hospital
Michelle Marie Andrade, 340B Program Manager
(603) 663-2430

Addresses

Street Address

15 Freetown Road, Ste 8
Raymond Shopping Center
Raymond, NH 03077

Billing Address

Elliot Hospital
1 Elliot Way
Manchester, NH 03103

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Elliot Hospital
1 Elliot Way
Manchester, NH 03103

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC300012-01	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- VASCULAR LAB - Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-02	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- CARDIOVASCULAR HEALTH - Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-03	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- PULMONARY TESTING - Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-04	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- PULMONARY REHAB - Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-05	Child	RRC	ELLIOT HOSPITAL	ELLIOT SENIOR HEALTH CENTER - Primary Care	138 Webster Street	Manchester	NH	Active
RRC300012-06	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- WOUND CENTER - Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-07	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE MRI - Radiology	185 Queen City Avenue	Manchester	NH	Active
RRC300012-08	Child	RRC	ELLIOT HOSPITAL	LONDONDERRY MRI - Radiology	40 Buttrick Road	Londonderry	NH	Active
RRC300012-09	Child	RRC	ELLIOT HOSPITAL	ELLIOT MEDICATION CLINIC- RIVER'S EDGE - CC	185 Queen City Avenue	Manchester	NH	Active
RRC300012-10	Child	RRC	ELLIOT HOSPITAL	ELLIOT MEDICATION CLINIC- RAYMOND - CC	15 Freetown Road, Ste 8	Raymond	NH	Active
RRC300012-11	Child	RRC	ELLIOT HOSPITAL	ELLIOT MEDICATION CLINIC- SENIOR HEALTH CENTER - CC	138 Webster Street	Manchester	NH	Active
RRC300012-12	Child	RRC	ELLIOT HOSPITAL	ELLIOT MEDICATION CLINIC- LONDONDERRY - CC	40 Buttrick Road	Londonderry	NH	Active
RRC300012-13	Child	RRC	ELLIOT HOSPITAL	ELLIOT URGENT CARE- BEDFORD - Urgent Care	25 Leavy Drive	Manchester	NH	Active
RRC300012-14	Child	RRC	ELLIOT HOSPITAL	ELLIOT URGENT CARE- RIVER'S EDGE - Urgent Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-15	Child	RRC	ELLIOT HOSPITAL	ELLIOT URGENT CARE- LONDONDERRY - Urgent Care	40 Buttrick Road	Londonderry	NH	Active
RRC300012-16	Child	RRC	ELLIOT HOSPITAL	ELLIOT BEHAVIORAL HEALTH - Partial Hospital Program	300 Hanover Street	Manchester	NH	Active
RRC300012-17	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- RHEUMATOLOGY - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-18	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- GENERAL SURGERY - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-19	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- PULMONARY MEDICINE - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-20	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- PLASTIC & RECONSTRUCTIVE SUGERY - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-21	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- ORTHOPEDIC SURGICAL SPECIALISTS - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-22	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- NEUROLOGY - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-23	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- BREAST HEALTH - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-24	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- GASTROENTEROLOGY - PBB Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-25	Child	RRC	ELLIOT HOSPITAL	ELLIOT PRIMARY CARE- RIVERSIDE - PBB Primary Care	20 Chambers Drive, Suite 2200	Hooksett	NH	Active
RRC300012-26	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- PAIN MANAGEMENT - Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-27	Child	RRC	ELLIOT HOSPITAL	RIVER'S EDGE- INTERVENTIONAL SPINE CENTER - Specialty Care	185 Queen City Avenue	Manchester	NH	Active
RRC300012-28	Child	RRC	ELLIOT HOSPITAL	BEDFORD- ELLIOT ENDOCRINOLOGY ASSOCIATES - Specialty Care	25 Leavy Drive	Bedford	NH	Active
RRC300012-29	Child	RRC	ELLIOT HOSPITAL	ELLIOT INTERNAL MEDICINE- LONDONDERRY - Internal Medicine	40 Buttrick Road	Londonderry	NH	Active
RRC300012-30	Child	RRC	ELLIOT HOSPITAL	ELLIOT FAMILY MEDICINE- WINDHAM - Family Medicine	5 Industrial Drive, Unit B	Windham	NH	Active
RRC300012-31	Child	RRC	ELLIOT HOSPITAL	ELLIOT PRIMARY CARE- BRIARWOOD - Primary Care	445 Cypress Street, Suite 5	Manchester	NH	Active
RRC300012-32	Child	RRC	ELLIOT HOSPITAL	ELLIOT FAMILY HEALTH CENTER- SUNCOOK - Family Medicine	50 Pinewood Road	Allenstown	NH	Active
RRC300012-33	Child	RRC	ELLIOT HOSPITAL	ELLIOT FAMILY MEDICINE- MANCHESTER - Family Medicine	130 Tarrytown Road	Manchester	NH	Active
RRC300012-34	Child	RRC	ELLIOT HOSPITAL	ELLIOT FAMILY MEDICINE- HOOKSETT - Family Medicine	20 Chambers Drive, Suite 1200	Hooksett	NH	Active
RRC300012-35	Child	RRC	ELLIOT HOSPITAL	ELLIOT INTERNAL MEDICINE- BEDFORD - Family Medicine	25 Leavy Drive	Manchester	NH	Active
RRC300012-36	Child	RRC	ELLIOT HOSPITAL	ELLIOT FAMILY MEDICINE- BEDFORD - Family Medicine	25 Leavy Drive	Bedford	NH	Active
RRC300012-37	Child	RRC	ELLIOT HOSPITAL	ELLIOT PRIMARY CARE - RAYMOND - Primary Care	15 Freetown Road, Ste 8	Raymond	NH	Active
RRC300012-38	Child	RRC	ELLIOT HOSPITAL	ELLIOT PRIMARY CARE- LONDONDERRY - Primary Care	40 Buttrick Road	Londonderry	NH	Active
RRC300012-39	Child	RRC	ELLIOT HOSPITAL	BEDFORD- DIABETES MANAGEMENT - Diabetes Counseling	25 Leavy Drive	Bedford	NH	Active
RRC300012-40	Child	RRC	ELLIOT HOSPITAL	DERRYFIELD MEDICAL GROUP - Primary Care	275 MAMMOTH RD	MANCHESTER	NH	Active
RRC300012-41	Child	RRC	ELLIOT HOSPITAL	ELLIOT MEDICATION CLINIC- SUNCOOK - Coumadin Clinic	50 Pinewood Road	Allenstown	NH	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	10/1/2024 12:01 AM
Addresses	Main Address	Insert	New Registration		15 Freetown Road, Ste 8 Raymond Shopping Center Raymond, NH 03077	8/29/2024 8:15 AM
Addresses	Billing Address	Insert	New Registration		Elliot Hospital 1 Elliot Way Manchester, NH 03103	8/29/2024 8:15 AM
Contacts	Signed By	Insert	New Registration		Curti, Joseph Tate COO Elliot Hospital 6036632082	8/29/2024 8:15 AM
Details	340B ID	Update	New Registration		RRC300012-10	8/29/2024 8:15 AM
Details	Entity Subname	Update	New Registration	ELLIOT MEDICATION CLINIC- RAYMOND	ELLIOT MEDICATION CLINIC- RAYMOND - CC	8/29/2024 8:15 AM
Dates	Participating Approval Date	Update	New Registration		8/29/2024 8:15:53 AM	8/29/2024 8:15 AM
Details	State	Update	New Registration	Pending	Approved	8/29/2024 8:15 AM
Dates	Signed By Date	Update	New Registration		7/15/2024 11:40:37 AM	8/29/2024 8:15 AM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/29/2024 8:15 AM
Addresses	Main Address	Insert	New Registration		15 Freetown Road, Ste 8 Raymond Shopping Center Raymond, NH 03077	7/15/2024 11:40 AM
Addresses	Billing Address	Insert	New Registration		Elliot Hospital 1 Elliot Way Manchester, NH 03103	7/15/2024 11:40 AM
Details	Entity Subname	Update	New Registration	ELLIOT MED CLINICAL- RAYMOND	ELLIOT MEDICATION CLINIC- RAYMOND	7/15/2024 11:40 AM
Addresses	Main Address	Insert	New Registration		15 Freetown Road, Ste 8 Raymond Shopping Center Raymond, NH 03077	7/13/2024 4:18 PM
Addresses	Billing Address	Insert	New Registration		Elliot Hospital 1 Elliot Way Manchester, NH 03103	7/13/2024 4:18 PM
Addresses	Shipping Address	Insert	New Registration		Elliot Hospital 1 Elliot Way Manchester, NH 03103	7/13/2024 4:18 PM
Contacts	Primary Contact	Insert	New Registration		Andrade, Michelle Marie 340B Program Manager Elliot Hospital 6036632430	7/13/2024 4:18 PM
Contacts	Authorizing Official	Insert	New Registration		Curti, Joseph Tate COO Elliot Hospital 6036632082	7/13/2024 4:18 PM
Details	Assistance Received From Date	Insert	New Registration			7/13/2024 4:18 PM
Details	Assistance Received To Date	Insert	New Registration			7/13/2024 4:18 PM
Details	Last Recertification Date	Insert	New Registration			7/13/2024 4:18 PM
Details	Grant Number	Insert	New Registration			7/13/2024 4:18 PM
Details	340B ID	Insert	New Registration			7/13/2024 4:18 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2024 4:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2024 4:18 PM
Details	Medicare Provider Number	Insert	New Registration		300012	7/13/2024 4:18 PM
Details	Entity Name	Insert	New Registration		ELLIOT HOSPITAL	7/13/2024 4:18 PM
Details	NOFO Number	Insert	New Registration			7/13/2024 4:18 PM
Details	Program Code	Insert	New Registration		RRC	7/13/2024 4:18 PM
Details	Entity Subname	Insert	New Registration		ELLIOT MED CLINICAL- RAYMOND	7/13/2024 4:18 PM
Dates	Participating Approval Date	Insert	New Registration			7/13/2024 4:18 PM
Details	State	Insert	New Registration		Pending	7/13/2024 4:18 PM
Dates	Registration Date	Insert	New Registration		7/13/2024 4:18:02 PM	7/13/2024 4:18 PM
Dates	Signed By Date	Insert	New Registration			7/13/2024 4:18 PM
Dates	Start Date	Insert	New Registration			7/13/2024 4:18 PM
Terminations	Termination Comments	Insert	New Registration			7/13/2024 4:18 PM
Terminations	Termination Date	Insert	New Registration			7/13/2024 4:18 PM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2024 4:18 PM
Terminations	Termination Reason	Insert	New Registration			7/13/2024 4:18 PM