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SUGAR RIVER PHARMACY, LLC
CAH301304-00 THE NEW LONDON HOSPITAL ASSOCIATION, INC
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Covered Entity Details
Entity Name
THE NEW LONDON HOSPITAL ASSOCIATION, INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301304-00
Entity Address
273 COUNTY ROAD
NEW LONDON, NH 03257
Medicare Provider Number
301304
Participating Start Date
9/20/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
SUGAR RIVER PHARMACY, LLC
Pharmacy Address
54 JOHN STARK HWY
NEWPORT, NH 03773
Pharmacy Comments
Contract Details
Approval Date
6/18/2012
Contract Begin Date
6/18/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Griffin, Chief Financial Officer
(603) 526-5372
Contract Pharmacy Representative
Sugar River Pharmacy
Chad Beane, Owner
(603) 393-8096
Signed By Date
5/11/2012
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