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DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
CAH471306-00 SPRINGFIELD HOSPITAL
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Covered Entity Details
Entity Name
SPRINGFIELD HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471306-00
Entity Address
25 RIDGEWOOD ROAD
SPRINGFIELD, VT 05156
Medicare Provider Number
471306
Participating Start Date
1/1/2011
Last Recertification Date
9/4/2024
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
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
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
4/9/2020
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