340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
CAH471301-00 GIFFORD MEDICAL CENTER
Print
Covered Entity Details
Entity Name
GIFFORD MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471301-00
Entity Address
44 SOUTH MAIN STREET
RANDOLPH, VT 05060
Medicare Provider Number
471301
Participating Start Date
7/1/2011
Last Recertification Date
8/16/2024
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
Dartmouth-Hitchcock
Patrick F. Jordan, Chief Operating Officier
(603) 650-5706
Signed By Date
10/12/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session