Contract Pharmacy Details

SUGAR RIVER PHARMACY, LLC
CAH301304-01 THE NEW LONDON HOSPITAL ASSOCIATION, INC

Covered Entity Details

Entity Name

THE NEW LONDON HOSPITAL ASSOCIATION, INC

Subdivision Name

THE NEWPORT HEALTH CENTER - RHC

Type

Critical Access Hospital

340B ID

CAH301304-01

Entity Address

11 JOHN STARK HIGHWAY
NEWPORT, NH 03773

Medicare Provider Number

301304

Outpatient Facility Provider Number

303978

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

Contract Termination Date
Termination Reason

11/19/2019
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database