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SUGAR RIVER PHARMACY, LLC
CAH301308-00 VALLEY REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
VALLEY REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301308-00
Entity Address
243 ELM STREET
CLAREMONT, NH 03743
Medicare Provider Number
301308
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
SUGAR RIVER PHARMACY, LLC
Pharmacy Address
54 JOHN STARK HWY
NEWPORT, NH 03773
Pharmacy Comments
Contract Details
Approval Date
1/10/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peter Wright, CHIEF Executive OFFICER
(603) 542-3400
Contract Pharmacy Representative
Sugar River Pharmacy
Chad Beane, Owner
(603) 393-8096
Signed By Date
1/10/2017
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