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ACCREDO HEALTH GROUP, INC.
HV00812 Mary Hitchcock Memorial Hospital dba Ryan White Program
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Covered Entity Details
Entity Name
Mary Hitchcock Memorial Hospital dba Ryan White Program
Subdivision Name
Ryan White Part C
Type
Ryan White Part C
340B ID
HV00812
Entity Address
One Medical Center Drive
Lebanon, NH 03756
Grant Number
H76HA31654
Participating Start Date
1/1/2015
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
7/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Staci A Hermann, CHIEF PHARMACY OFFICER
(603) 653-3160
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
7/7/2023
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