Contract Pharmacy Details

RITE AID OF NEW HAMPSHIRE, INC.
CAH301302-00 LITTLETON REGIONAL HOSPITAL

Covered Entity Details

Entity Name

LITTLETON REGIONAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH301302-00

Entity Address

600 ST. JOHNSBURY ROAD
LITTLETON, NH 03561

Medicare Provider Number

301302

Participating Start Date

4/1/2011

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW HAMPSHIRE, INC.

Pharmacy Address

RITE AID #4127
177 MAIN STREET
LANCASTER, NH 03584

Pharmacy Comments

Contract Details

Approval Date

4/3/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/25/2018
Ownership change

Contacts

Covered Entity Signing Official

Warren West, CHIEF EXECUTIVE OFFICER
(603) 444-9598

Contract Pharmacy Representative

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

Signed By Date

4/3/2014

340B Drug Pricing Program Database