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FIRST COLONY CORP
CAH301305-00 ALICE PECK DAY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ALICE PECK DAY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301305-00
Entity Address
10 ALICE PECK DAY DRIVE
LEBANON, NH 03766
Medicare Provider Number
301305
Participating Start Date
4/1/2020
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
FIRST COLONY CORP
Pharmacy Address
DBA: COLONIAL PHARMACY
PO BOX 10
82 NEWPORT RD
NEW LONDON, NH 03257
Pharmacy Comments
Contract Details
Approval Date
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Todd P Roberts, CFO
(603) 308-0082
Contract Pharmacy Representative
Independent Pharmacy
Glenn Perreault, Owner
(603) 526-2233
Signed By Date
4/4/2024
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