340B Drug Pricing Program Database
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DSH300003 MARY HITCHCOCK MEMORIAL HOSP (Active)
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Main Details
Name
MARY HITCHCOCK MEMORIAL HOSP
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH300003
Medicare Provider Number
300003
Additional Details
Current Program Status
Active
Registration Date
4/13/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/20/2022
Last Recertification Date
8/28/2024
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
One Medical Center Drive
LEBANON, NH 03756-0001
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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