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RITE AID OF NEW HAMPSHIRE, INC.
DSH300014 FRISBIE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
FRISBIE MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH300014
Entity Address
11 WHITEHALL ROAD
ROCHESTER, NH 03867
Medicare Provider Number
300014
Participating Start Date
7/1/2018
Last Recertification Date
8/20/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
RITE AID OF NEW HAMPSHIRE, INC.
Pharmacy Address
RITE AID #3589
829 NH ROUTE 11
FARMINGTON, NH 03835
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Robert Keith Cochrane, V.P. Finance/CFO
(603) 335-8125 Ext: 8125
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/14/2019
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