340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH300003M MARY HITCHCOCK MEMORIAL HOSP (Active)
Print
Main Details
Name
MARY HITCHCOCK MEMORIAL HOSP
Subdivision Name
DARTMOUTH-HITCHCOCK HEATER ROAD - Heater Dermatology MOHS-Skin Cancer Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH300003M
Medicare Provider Number
300003
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/13/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/16/2022
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
18 OLD ETNA RD
LEBANON, NH 03766-1937
Billing Address
Mary Hitchcock Memorial Hospital
One Medical Center Drive
LEBANON, NH 03756-0001
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
June 2025
June 2025
week
S
M
T
W
T
F
S
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
24
8
9
10
11
12
13
14
25
15
16
17
18
19
20
21
26
22
23
24
25
26
27
28
27
29
30
1
2
3
4
5
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