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VICTORY DISTRIBUTORS, LLC
CAH301304-00 THE NEW LONDON HOSPITAL ASSOCIATION, INC
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Covered Entity Details
Entity Name
THE NEW LONDON HOSPITAL ASSOCIATION, INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301304-00
Entity Address
273 COUNTY ROAD
NEW LONDON, NH 03257
Medicare Provider Number
301304
Participating Start Date
9/20/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
VICTORY DISTRIBUTORS, LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #83
73 FORT EDDY RD
CONCORD, NH 03301-7405
Pharmacy Comments
Contract Details
Approval Date
7/18/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Martin Thomas Manion, President and Chief Executive Officer
(603) 526-5241
Contract Pharmacy Representative
Hannaford
Mike Fish, Pharmacy District Manager
(518) 428-2712
Signed By Date
7/18/2023
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