340B Drug Pricing Program Database
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HV00812D Mary Hitchcock Memorial Hospital dba Ryan White Program (Active)
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Main Details
Name
Mary Hitchcock Memorial Hospital dba Ryan White Program
Subdivision Name
Ryan White Part C
Type
Ryan White Part C
340B ID
HV00812D
Grant Number
H76HA31654
Additional Details
Current Program Status
Active
Registration Date
10/7/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/11/2022
Last Recertification Date
2/14/2025
Time Period the Assistance was Received
4/1/2022 - 3/31/2025
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
580 Court Street
Keene, NH 03431
Billing Address
Mary Hitchcock Memorial Hospital
One Medical Center Drive
Lebanon, NH 03756-0001
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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