Contract Pharmacy Details

CVS MANCHESTER NH, L.L.C.
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

CVS MANCHESTER NH, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00650
1351 WHITE MOUNTAIN HWY
NORTHWAY SHPGPLZ
NORTH CONWAY, NH 03860

Pharmacy Comments

Contract Details

Approval Date

1/6/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/14/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Suzanne Landry, Vice President
(603) 326-5608

Contract Pharmacy Representative

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

Signed By Date

1/6/2023

340B Drug Pricing Program Database