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MAXI DRUG NORTH, INC.
CH010760A Amoskeag Health
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Covered Entity Details
Entity Name
Amoskeag Health
Subdivision Name
Amoskeag Health at 184 Tarrytown Road
Type
HRSA-Funded Health Center
340B ID
CH010760A
Entity Address
184 Tarrytown Rd
Manchester, NH 03103-2713
Grant Number
H80CS00571
Participating Start Date
7/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MAXI DRUG NORTH, INC.
Pharmacy Address
RITE AID #10278
270 MAMMOTH ROAD
MANCHESTER, NH 03109
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris McCracken, President/CEO
(603) 935-5210
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
10/14/2024
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