340B Drug Pricing Program Database
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DSH300003BY MARY HITCHCOCK MEMORIAL HOSP (Active)
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Main Details
Name
MARY HITCHCOCK MEMORIAL HOSP
Subdivision Name
MARY HITCHCOCK MEMORIAL HOSPITAL - Nashua Pulmonology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH300003BY
Medicare Provider Number
300003
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/9/2024
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Dartmouth Health
Keith B Thomasset, Chief Pharmacy Officer
(603) 656-0966
Primary Contact
Dartmouth-Hitchcock
Kristin A Chupka, Director - Pharmacy System 340B Program
(603) 656-0945
Addresses
Street Address
2300 SOUTHWOOD DR
1st Floor
NASHUA, NH 03063-1818
Billing Address
Mary Hitchcock Memorial Hospital
One Medical Center Drive
LEBANON, NH 03756-0001
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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