Contract Pharmacy Details

MAXI DRUG NORTH, INC.
HV00812B Mary Hitchcock Memorial Hospital dba Ryan White Program

Covered Entity Details

Entity Name

Mary Hitchcock Memorial Hospital dba Ryan White Program

Subdivision Name

Bedford Clinic, Ryan White Part C

Type

Ryan White Part C

340B ID

HV00812B

Entity Address

5 Washington Place
Bedford, NH 03110

Grant Number

H76HA31654

Participating Start Date

7/1/2016

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

MAXI DRUG NORTH, INC.

Pharmacy Address

RITE AID #10278
270 MAMMOTH ROAD
MANCHESTER, NH 03109

Pharmacy Comments

Contract Details

Approval Date

4/19/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/1/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

340B Drug Pricing Program Database