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DARTMOUTH-HITCHCOCK PHARMACY AT CENTERRA
HM2673 DARTMOUTH-HITCHCOCK HEMOPHILIA CENTER
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Covered Entity Details
Entity Name
DARTMOUTH-HITCHCOCK HEMOPHILIA CENTER
Subdivision Name
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM2673
Entity Address
1 MEDICAL CENTER DR.
LEBANON, NH 03756
Grant Number
H30MC24048
Participating Start Date
12/1/1992
Last Recertification Date
3/3/2025
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
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Staci A Hermann, CHIEF PHARMACY OFFICER
(603) 653-3160
Contract Pharmacy Representative
Dartmouth-Hitchcock
Patrick F. Jordan, Chief Operating Officier
(603) 650-5706
Signed By Date
1/13/2022
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