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MAXI DRUG NORTH, INC.
CAH301309-00 MONADNOCK COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MONADNOCK COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301309-00
Entity Address
452 OLD STREET ROAD
PETERBOROUGH, NH 03458
Medicare Provider Number
301309
Participating Start Date
9/29/2010
Last Recertification Date
9/16/2024
Pharmacy Details
Pharmacy Name
MAXI DRUG NORTH, INC.
Pharmacy Address
RITE AID #10285
19 WILTON ROAD
STE 1A
PETERBOROUGH, NH 03458-1799
Pharmacy Comments
Contract Details
Approval Date
9/12/2012
Contract Begin Date
10/1/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Scheinblum, CFO
(603) 924-4699 Ext: 1738
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
8/28/2012
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