340B Drug Pricing Program Database
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CAH301305-09 ALICE PECK DAY MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
ALICE PECK DAY MEMORIAL HOSPITAL
Subdivision Name
Occupational Medicine - Occupational Medicine
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH301305-09
Medicare Provider Number
301305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/20/2021
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Alice Peck Day Memorial Hospital
Todd P Roberts, CFO
(603) 308-0082
Primary Contact
Dartmouth-Hitchcock
Kristin A Chupka, Director - Pharmacy System 340B Program
(603) 656-0945
Addresses
Street Address
9 Alice Peck Day Drive
Lebanon, NH 03766
Billing Address
Alice Peck Day Memorial Hospital
10 Alice Peck Day Drive
Lebanon, NH 03766
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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