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RITE AID OF VERMONT, INC.
RW424881B Mary Hitchcock Memorial Hospital dba Ryan White Program
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Covered Entity Details
Entity Name
Mary Hitchcock Memorial Hospital dba Ryan White Program
Subdivision Name
Dartmouth-Hitchcock Nashua, Ryan White Part D
Type
Ryan White Part D
340B ID
RW424881B
Entity Address
2300 Southwood Drive
Nashua, NH 03063
Grant Number
H12HA31112
Participating Start Date
7/1/2016
Last Recertification Date
2/9/2018
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
RITE AID OF VERMONT, INC.
Pharmacy Address
RITE AID #1174
P.O. BOX 90
294 MAIN STREET
WEST RUTLAND, VT 05777
Pharmacy Comments
Contract Details
Approval Date
4/21/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2018
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
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