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NORTH COUNTRY HEALTHCARE PHARMACY
CAH301310-00 ANDROSCOGGIN VALLEY HOSPITAL , Inc.
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Covered Entity Details
Entity Name
ANDROSCOGGIN VALLEY HOSPITAL , Inc.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301310-00
Entity Address
59 PAGE HILL ROAD
BERLIN, NH 03570-3542
Medicare Provider Number
301310
Participating Start Date
9/29/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
NORTH COUNTRY HEALTHCARE PHARMACY
Pharmacy Address
141 CORLISS LN
COLEBROOK, NH 03576
Pharmacy Comments
Contract Details
Approval Date
7/6/2022
Contract Begin Date
7/26/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Suzanne Landry, Vice President
(603) 326-5608
Contract Pharmacy Representative
Weeks Medical Center
Michael Lee, President and Chief Executive Officer
(603) 788-5026
Signed By Date
7/6/2022
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