340B Drug Pricing Program Database
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RW431112D Mary Hitchcock Memorial Hospital dba Ryan White Program (Terminated)
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Main Details
Name
Mary Hitchcock Memorial Hospital dba Ryan White Program
Subdivision Name
Ryan White Part D
Type
Ryan White Part D
340B ID
RW431112D
Grant Number
H12HA31112
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/11/2022
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
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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