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CVS MANCHESTER NH, L.L.C.
DSH300012 ELLIOT HOSPITAL
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Covered Entity Details
Entity Name
ELLIOT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH300012
Entity Address
1 ELLIOT WAY
MANCHESTER, NH 03103
Medicare Provider Number
300012
Participating Start Date
3/12/2021
Last Recertification Date
9/14/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
CVS MANCHESTER NH, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07932
432 S. MAIN ST.
MANCHESTER, NH 03102
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Turilli, Vice President - Finance
(978) 430-1352
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2018
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