340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
RW431112C Mary Hitchcock Memorial Hospital dba Ryan White Program (Terminated)
Print
Main Details
Name
Mary Hitchcock Memorial Hospital dba Ryan White Program
Subdivision Name
Bedford Clinic, Ryan White Part D
Type
Ryan White Part D
340B ID
RW431112C
Grant Number
H12HA31112
Additional Details
Current Program Status
Terminated
Registration Date
12/13/2018
Participating Start Date
1/1/2019
Participating Approval Date
12/14/2018
Last Recertification Date
2/5/2024
Time Period the Assistance was Received
8/1/2022 - 7/31/2026
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
Dartmouth-Hitchcock
Patrick F. Jordan, Chief Operating Officier
(603) 650-5706
Primary Contact
Dartmouth-Hitchcock
Kristin A Chupka, Director - Pharmacy System 340B Program
(603) 656-0945
Addresses
Street Address
5 Washington Place
Bedford, NH 03110
Billing Address
Mary Hitchcock Memorial Hospital
One Medical Center Drive
Lebanon, NH 03756
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Based on documentation provided by the entity, OPA determined that the contract pharmacies were eligible back to January 1, 2018.
12/14/2018
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session