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MAXI DRUG NORTH, INC.
RRC300019-00 CHESHIRE MEDICAL CENTER
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Covered Entity Details
Entity Name
CHESHIRE MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC300019-00
Entity Address
580 COURT STREET
KEENE, NH 03431
Medicare Provider Number
300019
Participating Start Date
7/1/2023
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MAXI DRUG NORTH, INC.
Pharmacy Address
RITE AID #10285
19 WILTON ROAD
STE 1A
PETERBOROUGH, NH 03458-1799
Pharmacy Comments
Contract Details
Approval Date
5/2/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathryn Willbarger, COO
(603) 354-5488
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
4/14/2023
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