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FOUNDATION CARE LLC
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
FOUNDATION CARE LLC
Pharmacy Address
111 CHESTERFIELD INDUSTRIAL BLVD STE 115
CHESTERFIELD, MO 63005
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
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
AcariaHealth
Philip Golfman, Regional VP
(917) 312-5263
Signed By Date
7/14/2022
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