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ST JAY PHARMACY INC DBA
CH010980 AMMONOOSUC COMMUNITY HEALTH SERVICES INC
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Covered Entity Details
Entity Name
AMMONOOSUC COMMUNITY HEALTH SERVICES INC
Subdivision Name
ACHS - Littleton
Type
HRSA-Funded Health Center
340B ID
CH010980
Entity Address
25 Mount Eustis Rd
Littleton, NH 03561-3712
Grant Number
H80CS00554
Participating Start Date
4/1/1996
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
ST JAY PHARMACY INC DBA
Pharmacy Address
WELLS RIVER PHARMACY
PO BOX 671
41 MAIN STREET NORTH
WELLS RIVER, VT 05081
Pharmacy Comments
Contract Details
Approval Date
4/16/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/7/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EDWARD D. SHANSHALA II, CEO
(603) 444-8223
Contract Pharmacy Representative
Dennis Straight, Owner
(802) 757-2244
Signed By Date
4/16/2013
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