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RITE AID OF NEW HAMPSHIRE, INC.
CH010640 NORTHERN COUNTIES HEALTH CARE, INC
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Covered Entity Details
Entity Name
NORTHERN COUNTIES HEALTH CARE, INC
Subdivision Name
NORTHERN COUNTIES HEALTH CARE, INC.
Type
HRSA-Funded Health Center
340B ID
CH010640
Entity Address
165 Sherman Dr
Saint Johnsbury, VT 05819-9811
Grant Number
H80CS00632
Participating Start Date
9/1/2008
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
RITE AID OF NEW HAMPSHIRE, INC.
Pharmacy Address
RITE AID #4182
136 MEADOW STREET
LITTLETON, NH 03561
Pharmacy Comments
03/22/2013 address update (was 118-136 MEADOW STREET)
Contract Details
Approval Date
9/12/2012
Contract Begin Date
9/12/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Pitts, CFO
(802) 748-9405 Ext: 1599
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
8/30/2012
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