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DARTMOUTH-HITCHCOCK PHARMACY
CAH471302-00 WINDSOR HOSPITAL CORPORATION D/B/A MT. ASCUTNEY HOSPITAL AND HEALTH CENTER
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Covered Entity Details
Entity Name
WINDSOR HOSPITAL CORPORATION D/B/A MT. ASCUTNEY HOSPITAL AND HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471302-00
Entity Address
289 COUNTY ROAD
WINDSOR, VT 05089
Medicare Provider Number
471302
Participating Start Date
7/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
DARTMOUTH-HITCHCOCK PHARMACY
Pharmacy Address
1000 QUALITY DR
HOOKSETT, NH 03106
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David C. Sanville, Chief Financial Officer
(802) 674-7240
Contract Pharmacy Representative
Dartmouth-Hitchcock
Staci A Hermann, CHIEF PHARMACY OFFICER
(603) 653-3160
Signed By Date
1/14/2022
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