Contract Pharmacy Details

ACARIAHEALTH PHARMACY #12, INC.
CAH301310-00 ANDROSCOGGIN VALLEY HOSPITAL , Inc.

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

ACARIAHEALTH PHARMACY #12, INC.

Pharmacy Address

5 SKYLINE DR STE 240
HAWTHORNE, NY 10532-2166

Pharmacy Comments

Contract Details

Approval Date

7/14/2022

Contract Begin Date

7/26/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Suzanne Landry, Vice President
(603) 326-5608

Contract Pharmacy Representative

AcariaHealth
Philip Golfman, Regional VP
(917) 312-5263

Signed By Date

7/14/2022

340B Drug Pricing Program Database