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DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
CAH471301-10 GIFFORD MEDICAL CENTER
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Covered Entity Details
Entity Name
GIFFORD MEDICAL CENTER
Subdivision Name
SHARON HEALTH CENTER
Type
Critical Access Hospital
340B ID
CAH471301-10
Entity Address
12 SHIPPEE LANE
SHARON, VT 05065
Medicare Provider Number
471301
Outpatient Facility Provider Number
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
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
10/12/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Bennett, CEO
(802) 728-2304
Contract Pharmacy Representative
Mary Hitchcock Memorial Hospital
Curtis A. Gibbon, Director - Retail Pharmacy
(603) 308-2287
Signed By Date
10/12/2020
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