Contract Pharmacy Details

CVS MANCHESTER NH, L.L.C.
CAH471302-00 WINDSOR HOSPITAL CORPORATION D/B/A MT. ASCUTNEY HOSPITAL AND HEALTH CENTER

Covered Entity Details

Entity Name

WINDSOR HOSPITAL CORPORATION D/B/A MT. ASCUTNEY HOSPITAL AND HEALTH CENTER

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH471302-00

Entity Address

289 COUNTY ROAD
WINDSOR, VT 05089

Medicare Provider Number

471302

Participating Start Date

7/1/2011

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

CVS MANCHESTER NH, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00647
250 PLAINFIELD RD.
UPPER VALLEY PLAZA
WEST LEBANON, NH 03784

Pharmacy Comments

Contract Details

Approval Date

7/15/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

David C. Sanville, Chief Financial Officer
(802) 674-7240

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/15/2019

340B Drug Pricing Program Database