Contract Pharmacy Details

CVS MANCHESTER NH, L.L.C.
HV00812C Mary Hitchcock Memorial Hospital dba Ryan White Program

Covered Entity Details

Entity Name

Mary Hitchcock Memorial Hospital dba Ryan White Program

Subdivision Name

Dartmouth-Hitchcock Nashua, Ryan White Part C

Type

Ryan White Part C

340B ID

HV00812C

Entity Address

2300 Southwood Drive
Nashua, NH 03063

Grant Number

H76HA31654

Participating Start Date

7/1/2016

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

CVS MANCHESTER NH, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07932
432 S. MAIN ST.
MANCHESTER, NH 03102

Pharmacy Comments

Contract Details

Approval Date

10/20/2022

Contract Begin Date

10/25/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Staci A Hermann, CHIEF PHARMACY OFFICER
(603) 653-3160

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/20/2022

340B Drug Pricing Program Database