CLAREMONT — Valley Regional Hospital and Dartmouth Health have signed a letter of intent to affiliate, the two institutions announced on Wednesday.

If the affiliation is approved, Valley Regional would join the ranks of other small Upper Valley hospitals that in the past decade have become part of the DH health care behemoth.

“We believe that collaboration among providers is the most effective way to deliver that care. To that end, Valley Regional and Dartmouth Health have signed a letter of intent to begin the process of strengthening our relationship by having Valley Regional Hospital become part of the Dartmouth Health system,” according to a statement posted on Valley Regional’s website. “We are at the very beginning of a robust process of due diligence and regulatory review.”

Dartmouth Health has formal affiliations with multiple hospitals in the region, including New London Hospital in 2013 and Windsor’s Mt. Ascutney Hospital and Health Center in 2014.

DH leapfrogged the Claremont market in 2015 to finalize an affiliation with Cheshire Medical Center in Keene in the southwest corner of the state.

And in 2016, DH finalized an affiliation with Alice Peck Day in Lebanon.

As with previous affiliations, this one requires the approval of the state Attorney General’s Office.

While not formal affiliates, Dartmouth Health, formerly known as Dartmouth-Hitchcock Health, and Valley Regional have had a close business relationship.

Valley Regional’s former CEO, Peter Wright, was a Dartmouth-Hitchcock employee hired in 2013 under a business services agreement with Valley Regional.

Valley Regional has been without a permanent CEO since well before the pandemic.

Wright announced his departure in January 2019.

Deanna Howard, a former DH executive, served as interim CEO for 18 months until stepping down August 2020.

Jocelyn Caple, who joined Valley Regional as chief medical officer that same month, took over the interim CEO role in September 2020.

The announcement of its plans with Valley Regional comes three months after DH’s pursuit of a much grander affiliation in southern New Hampshire failed to materialize.

New Hampshire Attorney General John Formella rejected DH’s proposal to merge with Manchester’s Catholic Medical Center, which has about 400 beds.

Formella cited concerns the merger would stifle competition in the state’s health care marketplace.

Another attempted foray into the southern tier — an affiliation with the 300-bed Elliot Hospital in Manchester — ended when the two sides abandoned talks in 2017.

By comparison, Valley Regional has just 25 beds.

To kick off the affiliation process, Valley Regional and Dartmouth Health officials will hold an in-person and virtual “public listening session” to discuss the proposal at 5:30 p.m. Thursday, Sept. 8, at Claremont Savings Bank at 145 Broad St. in Claremont.

Those who attend will be able to ask questions after the presentation. Registration is at vrh.org/affiliation.

Among those at the event will be Caple; Joanne M. Conroy, president and CEO of Dartmouth Health; Joseph Perras, CEO and CMO of Mt. Ascutney Hospital and Health Center; and Patricia Putnam, chairwoman of Valley Regional’s board of trustees.

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