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RITE AID OF NEW HAMPSHIRE, INC.
CAH301311-00 SPEARE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SPEARE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301311-00
Entity Address
16 HOSPITAL ROAD
PLYMOUTH, NH 03264
Medicare Provider Number
301311
Participating Start Date
9/30/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW HAMPSHIRE, INC.
Pharmacy Address
RITE AID #4166
360 SUMMER STREET
BRISTOL, NH 03222
Pharmacy Comments
Contract Details
Approval Date
12/4/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Crystal Cascadden, Pharmacy Director
(603) 238-2226 Ext: 385
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/4/2012
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