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DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
CHC11353-12 SPRINGFIELD MEDICAL CARE SYSTEMS INC
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Covered Entity Details
Entity Name
SPRINGFIELD MEDICAL CARE SYSTEMS INC
Subdivision Name
Lane Eye Associates
Type
HRSA-Funded Health Center
340B ID
CHC11353-12
Entity Address
441 River Street
North Springfield, VT 05150-9756
Grant Number
H80CS12873
Participating Start Date
1/1/2017
Last Recertification Date
1/30/2024
Entity Termination Date
4/1/2025
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
10/18/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joshua Dufresne, CEO
(802) 886-8961
Contract Pharmacy Representative
Dartmouth-Hitchcock Health
Linda M Sawyer, Sr Director Pharmacy Retail and Specialty Pharmacy
(603) 308-2282
Signed By Date
10/18/2019
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