Covered Entity Details

CH01098G AMMONOOSUC COMMUNITY HEALTH SERVICES INC (Active) - information as of 6/17/2025 11:43:38 PM

Main Details

Name

AMMONOOSUC COMMUNITY HEALTH SERVICES INC

Subdivision Name

ACHS - Franconia Alpine

Type

HRSA-Funded Health Center

Site ID

BPS-H80-021003

340B ID

CH01098G

Grant Number

H80CS00554

Additional Details

Current Program Status

Active

Registration Date

1/2/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/9/2018

Last Recertification Date

2/17/2025

Contacts

Authorizing Official

Ammonoosuc Community Health Services, Inc.,
EDWARD D. SHANSHALA II, CEO
(603) 444-8223

Primary Contact

Ammonoosuc Community Health Services, Inc.
Lisa Mackenzie, Executive Assistant/ 340B Program Manager
(603) 444-8202

Addresses

Street Address

1095 Profile Road
B
Franconia, NH 03580

Billing Address

Ammonoosuc Community Health Services Inc.
25 Mt Eustis Road
Littleton, NH 03561

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	GENOA HEALTHCARE LLC	25 MOUNT EUSTIS RD RM P		LITTLETON	NH	03561	01/03/2024	04/01/2024	04/01/2024
Contract Detail	RITE AID OF NEW HAMPSHIRE, INC.	RITE AID #4182	136 MEADOW STREET	LITTLETON	NH	03561	04/03/2024	07/01/2024	07/01/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/03/2024	07/01/2024	07/01/2024
Contract Detail	WAL-MART PHARMACY 10-2681	615 MEADOW STREET		LITTLETON	NH	03561	04/03/2024	07/01/2024	07/01/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/03/2024	07/01/2024	07/01/2024
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17167	177 MAIN ST.	LANCASTER	NH	03584	04/03/2024	07/01/2024	07/01/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10410	274 DELLS ROAD	LITTLETON	NH	03561	04/03/2024	07/01/2024	07/01/2024
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/03/2024	07/01/2024	07/01/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/03/2024	07/01/2024	07/01/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	04/03/2024	07/01/2024	07/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH010980	Active	BPS-H80-001067	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	ACHS - Littleton	25 Mount Eustis Rd	Littleton	NH
CH01098A	Active	BPS-H80-004211	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	ACHS - Warren	333 NH Route 25	Warren	NH
CH01098B	Active	BPS-H80-004046	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	ACHS - Woodsville	79 Swiftwater Rd	Woodsville	NH
CH01098C	Active	BPS-H80-005120	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	ACHS - Whitefield	14 King Sq	Whitefield	NH
CH01098E	Terminated	BPS-H80-004450	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	FRANCONIA FAMILY HEALTH CENTER	155 Main St	Franconia	NH
CH01098F	Terminated	BPS-H80-017687	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	ACHS - Littleton II	202 Cottage Street	Littleton	NH
CH01098G	Active	BPS-H80-021003	AMMONOOSUC COMMUNITY HEALTH SERVICES INC	ACHS - Franconia Alpine	1095 Profile Road	Franconia	NH

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH010980	AMMONOOSUC COMMUNITY HEALTH SERVICES	AMMONOOSUC COMMUNITY HEALTH SERVICES	25 MOUNT EUSTIS ROAD	LITTLETON	NH	03561	02/06/2012	03/31/2018
CH01098A	GENOA HEALTHCARE LLC	25 MOUNT EUSTIS RD RM P		LITTLETON	NH	03561	04/01/2024
CH01098G	GENOA HEALTHCARE LLC	25 MOUNT EUSTIS RD RM P		LITTLETON	NH	03561	04/01/2024
CH010980	GENOA HEALTHCARE LLC	25 MOUNT EUSTIS RD RM P		LITTLETON	NH	03561	04/01/2024
CH01098C	GENOA HEALTHCARE LLC	25 MOUNT EUSTIS RD RM P		LITTLETON	NH	03561	04/01/2024
CH01098B	GENOA HEALTHCARE LLC	25 MOUNT EUSTIS RD RM P		LITTLETON	NH	03561	04/01/2024
CH010980	RITE AID OF NEW HAMPSHIRE, INC.	RITE AID #4871	4976 DARTMOUTH COLLEGE HIGHWAY	WOODSVILLE	NH	03785	10/01/2014	09/14/2023
CH010980	RITE AID OF NEW HAMPSHIRE, INC.	RITE AID #4182	136 MEADOW STREET	LITTLETON	NH	03561	10/01/2014
CH010980	RITE AID OF NEW HAMPSHIRE, INC.	RITE AID #4127	177 MAIN STREET	LANCASTER	NH	03584	01/01/2017	01/25/2018
CH01098G	RITE AID OF NEW HAMPSHIRE, INC.	RITE AID #4182	136 MEADOW STREET	LITTLETON	NH	03561	07/01/2024
CH01098C	RITE AID OF NEW HAMPSHIRE, INC.	RITE AID #4182	136 MEADOW STREET	LITTLETON	NH	03561	07/01/2024
CH01098B	RITE AID OF NEW HAMPSHIRE, INC.	RITE AID #4182	136 MEADOW STREET	LITTLETON	NH	03561	07/01/2024
CH010980	SHAWS SUPERMARKETS INC	SHAWS PHARMACY #2601	625 MEADOW STREET	LITTLETON	NH	03561	01/01/2018	10/30/2022
CH010980	ST JAY PHARMACY INC DBA	WELLS RIVER PHARMACY	PO BOX 671 41 MAIN STREET NORTH	WELLS RIVER	VT	05081	07/01/2013	07/07/2016
CH01098B	ST JAY PHARMACY INC DBA	WELLS RIVER PHARMACY	PO BOX 671 41 MAIN STREET NORTH	WELLS RIVER	VT	05081	10/01/2007	07/07/2016
CH010980	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH01098B	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2024
CH01098G	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2024
CH01098A	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2024
CH01098C	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2024
CH010980	WAL-MART PHARMACY 10-2681	615 MEADOW STREET		LITTLETON	NH	03561	10/01/2014
CH01098G	WAL-MART PHARMACY 10-2681	615 MEADOW STREET		LITTLETON	NH	03561	07/01/2024
CH01098C	WAL-MART PHARMACY 10-2681	615 MEADOW STREET		LITTLETON	NH	03561	07/01/2024
CH010980	WAL-MART PHARMACY 10-2758	683 TENNY MOUNTAIN HIGHWAY		PLYMOUTH	NH	03264	01/01/2017	03/11/2023
CH010980	WAL-MART PHARMACY 10-4389	WAL-MART STORES EAST, LP	4901 DARTMOUTH COLLEGE HWY	WOODSVILLE	NH	03785	10/01/2014
CH01098B	WAL-MART PHARMACY 10-4389	WAL-MART STORES EAST, LP	4901 DARTMOUTH COLLEGE HWY	WOODSVILLE	NH	03785	07/01/2024
CH01098A	WAL-MART PHARMACY 10-4389	WAL-MART STORES EAST, LP	4901 DARTMOUTH COLLEGE HWY	WOODSVILLE	NH	03785	07/01/2024
CH010980	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH01098A	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2024
CH01098C	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2024
CH01098G	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2024
CH01098B	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2024
CH010980	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10410	274 DELLS ROAD	LITTLETON	NH	03561	10/01/2014
CH010980	WALGREEN EASTERN CO., INC.	WALGREENS #17167	177 MAIN ST.	LANCASTER	NH	03584	07/05/2018
CH010980	WALGREEN EASTERN CO., INC.	WALGREENS #18090	502 RAILROAD ST.	SAINT JOHNSBURY	VT	05819	07/01/2019	02/22/2023
CH01098C	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10410	274 DELLS ROAD	LITTLETON	NH	03561	07/01/2024
CH01098C	WALGREEN EASTERN CO., INC.	WALGREENS #17167	177 MAIN ST.	LANCASTER	NH	03584	07/01/2024
CH01098G	WALGREEN EASTERN CO., INC.	WALGREENS #17167	177 MAIN ST.	LANCASTER	NH	03584	07/01/2024
CH01098G	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10410	274 DELLS ROAD	LITTLETON	NH	03561	07/01/2024
CH010980	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/01/2023
CH01098C	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	07/01/2024
CH01098G	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	07/01/2024
CH010980	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2014	07/22/2015
CH010980	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2014	07/22/2015
CH010980	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH01098C	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CH01098A	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CH01098G	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CH01098B	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2024
CH010980	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CH01098C	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024
CH01098A	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024
CH01098G	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024
CH01098B	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 12:41:57 AM	2/17/2025 8:38:01 AM	2/17/2025 8:38 AM
Details	Last Recertification Date	Update	Recertification	2/9/2023 4:52:59 PM	2/1/2024 12:41:57 AM	2/1/2024 12:41 AM
Addresses	Main Address	Update	Recertification	1095 Profile Road Franconia, NH 03580	1095 Profile Road B Franconia, NH 03580	2/9/2023 4:52 PM
Details	Last Recertification Date	Update	Recertification	2/11/2022 11:02:53 AM	2/9/2023 4:52:59 PM	2/9/2023 4:52 PM
Details	Last Recertification Date	Update	Recertification	2/12/2021 9:02:13 AM	2/11/2022 11:02:53 AM	2/11/2022 11:02 AM
Details	Last Recertification Date	Update	Recertification	2/4/2020 10:48:31 AM	2/12/2021 9:02:13 AM	2/12/2021 9:02 AM
Addresses	Billing Address	Insert	Recertification		Ammonoosuc Community Health Services Inc. 25 Mt Eustis Road Littleton, NH 03561	2/4/2020 10:48 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 1:17:05 PM	2/4/2020 10:48:31 AM	2/4/2020 10:48 AM
Contacts	Primary Contact	Update	Profile Change Request	Mackenzie, Lisa Pharmacy Operations Manager/ 340B Program Manager Ammonoosuc Community Health Services, Inc. 6034448269	Mackenzie, Lisa Executive Assistant/ 340B Program Manager Ammonoosuc Community Health Services, Inc. 6034448202	1/31/2020 2:28 PM
Details	Last Recertification Date	Update	Recertification		1/30/2019 1:17:05 PM	1/30/2019 1:17 PM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		SHANSHALA II, EDWARD D. CEO Ammonoosuc Community Health Services, Inc., 6034448223	1/9/2018 10:33 AM
Details	340B ID	Update	New Registration		CH01098G	1/9/2018 10:33 AM
Dates	Participating Approval Date	Update	New Registration		1/9/2018 10:33:44 AM	1/9/2018 10:33 AM
Details	State	Update	New Registration	Pending	Approved	1/9/2018 10:33 AM
Dates	Signed By Date	Update	New Registration		1/8/2018 12:08:36 PM	1/9/2018 10:33 AM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/9/2018 10:33 AM
Addresses	Main Address	Insert	New Registration		1095 Profile Road Franconia, NH 03580	1/2/2018 10:32 AM
Contacts	Primary Contact	Insert	New Registration		Mackenzie, Lisa Pharmacy Operations Manager/ 340B Program Manager Ammonoosuc Community Health Services, Inc. 6034448269	1/2/2018 10:32 AM
Contacts	Authorizing Official	Insert	New Registration		SHANSHALA II, EDWARD D. CEO Ammonoosuc Community Health Services, Inc., 6034448223	1/2/2018 10:32 AM
Details	Last Recertification Date	Insert	New Registration			1/2/2018 10:32 AM
Details	Grant Number	Insert	New Registration		H80CS00554	1/2/2018 10:32 AM
Details	340B ID	Insert	New Registration			1/2/2018 10:32 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/2/2018 10:32 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/2/2018 10:32 AM
Details	Medicare Provider Number	Insert	New Registration			1/2/2018 10:32 AM
Details	Entity Name	Insert	New Registration		AMMONOOSUC COMMUNITY HEALTH SERVICES INC	1/2/2018 10:32 AM
Details	Program Code	Insert	New Registration		CH	1/2/2018 10:32 AM
Details	Entity Subname	Insert	New Registration		ACHS - Franconia Alpine	1/2/2018 10:32 AM
Dates	Participating Approval Date	Insert	New Registration			1/2/2018 10:32 AM
Details	State	Insert	New Registration		Pending	1/2/2018 10:32 AM
Dates	Registration Date	Insert	New Registration		1/2/2018 10:32:51 AM	1/2/2018 10:32 AM
Dates	Signed By Date	Insert	New Registration			1/2/2018 10:32 AM
Dates	Start Date	Insert	New Registration			1/2/2018 10:32 AM
Terminations	Termination Comments	Insert	New Registration			1/2/2018 10:32 AM
Terminations	Termination Date	Insert	New Registration			1/2/2018 10:32 AM
Terminations	Termination Effective Date	Insert	New Registration			1/2/2018 10:32 AM
Terminations	Termination Reason	Insert	New Registration			1/2/2018 10:32 AM

340B Drug Pricing Program Database