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MAXI DRUG NORTH, INC.
CH019980 GOODWIN COMMUNITY HEALTH
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Covered Entity Details
Entity Name
GOODWIN COMMUNITY HEALTH
Subdivision Name
Somersworth Facility
Type
HRSA-Funded Health Center
340B ID
CH019980
Entity Address
311 Route 108
Somersworth, NH 03878-1522
Grant Number
H80CS04210
Participating Start Date
4/1/2001
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MAXI DRUG NORTH, INC.
Pharmacy Address
RITE AID #10290
1390 LAFAYETTE ROAD UNIT A
PORTSMOUTH, NH 03801
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JANET LAATSCH, EXECUTIVE DIRECTOR
(603) 516-2550
Contract Pharmacy Representative
CaptureRx
Alfred Shuler Jr., Customer Relations Manager
(210) 587-3486 Ext: 246
Signed By Date
1/12/2018
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