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DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
CHC26798-01 Gifford Health Care, Inc.
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Covered Entity Details
Entity Name
Gifford Health Care, Inc.
Subdivision Name
Gifford Primary Care
Type
HRSA-Funded Health Center
340B ID
CHC26798-01
Entity Address
44 S Main St Ste 2
Randolph, VT 05060-1381
Grant Number
H80CS26798
Participating Start Date
7/1/2014
Last Recertification Date
2/9/2023
Entity Termination Date
4/1/2024
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
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
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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