Contract Pharmacy Details

RITE AID OF NEW HAMPSHIRE, INC.
RW431112C Mary Hitchcock Memorial Hospital dba Ryan White Program

Covered Entity Details

Entity Name

Mary Hitchcock Memorial Hospital dba Ryan White Program

Subdivision Name

Bedford Clinic, Ryan White Part D

Type

Ryan White Part D

340B ID

RW431112C

Entity Address

5 Washington Place
Bedford, NH 03110

Grant Number

H12HA31112

Participating Start Date

1/1/2019

Last Recertification Date

2/5/2024

Entity Termination Date

10/1/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW HAMPSHIRE, INC.

Pharmacy Address

RITE AID #4282
92 SOUTH STREET
CONCORD, NH 03301

Pharmacy Comments

Contract Details

Approval Date

12/14/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/1/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Staci A Hermann, CHIEF PHARMACY OFFICER
(603) 653-3160

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

12/14/2018

340B Drug Pricing Program Database