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CVS MANCHESTER NH, L.L.C.
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
CVS MANCHESTER NH, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY #04314
338 HIGH ST.
SOMERSWORTH, NH 03878
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2019
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