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DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
CAH301312-00 HUGGINS HOSPITAL
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Covered Entity Details
Entity Name
HUGGINS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301312-00
Entity Address
240 SOUTH MAIN STREET
WOLFEBORO, NH 03894-0912
Medicare Provider Number
301312
Participating Start Date
9/29/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
Pharmacy Address
12 CENTERRA PKWY STE 10
LEBANON, NH 03766
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeremy Roberge, CEO
(603) 569-7507
Contract Pharmacy Representative
Dartmouth-Hitchcock Health
Linda M Sawyer, Sr Director Pharmacy Retail and Specialty Pharmacy
(603) 308-2282
Signed By Date
10/16/2019
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