Contract Pharmacy Details

RITE AID OF NEW HAMPSHIRE, INC.
CAH301303-01 WEEKS MEDICAL CENTER

Covered Entity Details

Entity Name

WEEKS MEDICAL CENTER

Subdivision Name

WEEKS MEDICAL CENTER-SWING BED

Type

Critical Access Hospital

340B ID

CAH301303-01

Entity Address

173 MIDDLE STREET
LANCASTER, NH 03584

Medicare Provider Number

301303

Outpatient Facility Provider Number

Participating Start Date

9/24/2010

Last Recertification Date

8/10/2015

Entity Termination Date

4/1/2016

Pharmacy Details

Pharmacy Name

RITE AID OF NEW HAMPSHIRE, INC.

Pharmacy Address

RITE AID #4138
91 MAIN STREET
COLEBROOK, NH 03576

Pharmacy Comments

Contract Details

Approval Date

10/12/2012

Contract Begin Date

10/12/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2016

Contacts

Covered Entity Signing Official

CELESTE PITTS, Vice President of Finance
(603) 788-5321

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

9/11/2012

340B Drug Pricing Program Database