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MAXI DRUG NORTH, INC.
CAH301303-01 WEEKS MEDICAL CENTER
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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
MAXI DRUG NORTH, INC.
Pharmacy Address
RITE AID #10287
200 PLEASANT STREET
BERLIN, NH 03570
Pharmacy Comments
Contract Details
Approval Date
10/13/2014
Contract Begin Date
1/1/2015
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 Corp.
Wendy Barnes, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
10/13/2014
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