Covered Entity Details

CHC00396-09 FISH RIVER RURAL HEALTH (Active) - information as of 5/17/2025 10:52:56 PM

Main Details

Name

FISH RIVER RURAL HEALTH

Subdivision Name

School-Based Health Center-Fort Kent High School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-035068

340B ID

CHC00396-09

Grant Number

H80CS00396

Additional Details

Current Program Status

Active

Registration Date

1/10/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/28/2025

Last Recertification Date

Contacts

Authorizing Official

Fish River Rural Health
Heather A Pelletier, Executive Director/CEO
(207) 444-5973 Ext: 218

Primary Contact

Fish River Rural Health
Jane Dubois, CFO
(207) 444-5973 Ext: 214

Addresses

Street Address

84 Pleasant St
Fort Kent, ME 04743-1574

Billing Address

Fish River Rural Health
PO Box 309
Eagle Lake, ME 04739

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC00396-00	Active	BPS-H80-002678	FISH RIVER RURAL HEALTH	EAGLE LAKE HEALTH CENTER	10 CARTER STREET	EAGLE LAKE	ME
CHC00396-01	Active	BPS-H80-012310	FISH RIVER RURAL HEALTH	Fort Kent Health Education & Training Center	3 Mountainview Dr	Fort Kent	ME
CHC00396-02	Active	BPS-H80-015349	FISH RIVER RURAL HEALTH	Bolduc Avenue Health Center	12 Bolduc Avenue	Fort Kent	ME
CHC00396-03	Active	BPS-H80-018634	FISH RIVER RURAL HEALTH	Madawaska Community Health Center	309 Saint Thomas Street	Madawaska	ME
CHC00396-04	Active	BPS-H80-034985	FISH RIVER RURAL HEALTH	School-Based Health Center-Madawaska High School	135 7th Ave	Madawaska	ME
CHC00396-05	Active	BPS-H80-035647	FISH RIVER RURAL HEALTH	School-Based Health Center-St. John Valley Technology Center	431 US Route 1	Frenchville	ME
CHC00396-06	Active	BPS-H80-035045	FISH RIVER RURAL HEALTH	School-Based Health Center-St. Agatha	368 Main St	Saint Agatha	ME
CHC00396-07	Active	BPS-H80-030113	FISH RIVER RURAL HEALTH	School-Based Health Center-Van Buren	169 Main St	Van Buren	ME
CHC00396-08	Active	BPS-H80-030128	FISH RIVER RURAL HEALTH	School-Based Health Center-Madawaska	353 11th Ave	Madawaska	ME
CHC00396-09	Active	BPS-H80-035068	FISH RIVER RURAL HEALTH	School-Based Health Center-Fort Kent High School	84 Pleasant St	Fort Kent	ME
CHC00396-10	Active	BPS-H80-007493	FISH RIVER RURAL HEALTH	MERCY HOME	3388 Aroostook Rd	Eagle Lake	ME
CHC00396-11	Active	BPS-H80-006787	FISH RIVER RURAL HEALTH	FOREST HILL MANOR	25 Bolduc Ave	Fort Kent	ME
CHC00396-12	Active	BPS-H80-035003	FISH RIVER RURAL HEALTH	School-Based Health Center-Fort Kent Elementary	108 Pleasant St	Fort Kent	ME
CHC00396-13	Active	BPS-H80-029759	FISH RIVER RURAL HEALTH	School Based Health Center Mobile Unit	3 Mountainview Dr	Fort Kent	ME

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC00396-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2024
CHC00396-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2024
CHC00396-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2024
CHC00396-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2024
CHC00396-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2024
CHC00396-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2024
CHC00396-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2024
CHC00396-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2024
CHC00396-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2024
CHC00396-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2024
CHC00396-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2024
CHC00396-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2024
CHC00396-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2024
CHC00396-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2024
CHC00396-00	NORTHERN MAINE MEDICAL CENTER PHARMACY	194 E MAIN ST		FORT KENT	ME	04743-1428	07/01/2020
CHC00396-00	NORTHERN MAINE MEDICAL CENTER PHARMACY	104 MAIN ST		MADAWASKA	ME	04756-1437	07/01/2020
CHC00396-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2024
CHC00396-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2024
CHC00396-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2024
CHC00396-00	RITE AID OF MAINE, INC.	RITE AID #2800	84 EAST MAIN STREET	FORT KENT	ME	04743	04/01/2015	01/25/2018
CHC00396-00	ST JOHN VALLEY PHARMACY	182 MARKET ST STE 2		FORT KENT	ME	04743	01/10/2025
CHC00396-00	ST JOHN VALLEY PHARMACY LLC	182 MARKET ST	PO BOX 189	FORT KENT	ME	04743	11/28/2011	01/07/2025
CHC00396-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2024
CHC00396-00	WAL-MART PHARMACY 10-1924	781 MAIN ST		PRESQUE ISLE	ME	04769	10/01/2024
CHC00396-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2024
CHC00396-00	WALGREEN EASTERN CO., INC.	WALGREENS #19241	84 E MAIN ST	FORT KENT	ME	04743-1322	01/31/2018
CHC00396-00	WALGREEN EASTERN CO., INC.	WALGREENS #19304	429 MAIN ST	MADAWASKA	ME	04756-1082	07/01/2018
CHC00396-00	WALGREEN EASTERN CO., INC.	RITE AID #03900	21 MAIN ST	VAN BUREN	ME	04785	07/01/2018	05/21/2018
CHC00396-00	WALGREEN EASTERN CO., INC.	WALGREENS #18248	112 BENNETT DR	CARIBOU	ME	04736	07/01/2018
CHC00396-00	WALGREEN EASTERN CO., INC.	WALGREENS #17152	320 MAIN ST	PRESQUE ISLE	ME	04769-2809	10/01/2024
CHC00396-00	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/01/2023
CHC00396-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2024
CHC00396-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/01/2024
CHC00396-00	WEST MAIN PHARMACY INC	342 W MAIN ST STE 101B		FORT KENT	ME	04743-1132	01/01/2025

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Pelletier, Heather A Executive Director/CEO Fish River Rural Health 2074445973-218	1/28/2025 10:23 AM
Details	340B ID	Update	New Registration		CHC00396-09	1/28/2025 10:23 AM
Dates	Participating Approval Date	Update	New Registration		1/28/2025 10:23:47 AM	1/28/2025 10:23 AM
Details	State	Update	New Registration	Pending	Approved	1/28/2025 10:23 AM
Dates	Signed By Date	Update	New Registration		1/10/2025 2:09:29 PM	1/28/2025 10:23 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	1/28/2025 10:23 AM
Addresses	Main Address	Insert	New Registration		84 Pleasant St Fort Kent, ME 04743-1574	1/10/2025 2:09 PM
Addresses	Billing Address	Insert	New Registration		Fish River Rural Health PO Box 309 Eagle Lake, ME 04739	1/10/2025 2:09 PM
Contacts	Authorizing Official	Insert	New Registration		Pelletier, Heather A Executive Director/CEO Fish River Rural Health 2074445973-218	1/10/2025 2:09 PM
Contacts	Primary Contact	Insert	New Registration		Dubois, Jane CFO Fish River Rural Health 2074445973-214	1/10/2025 2:09 PM
Details	Assistance Received From Date	Insert	New Registration			1/10/2025 2:09 PM
Details	Assistance Received To Date	Insert	New Registration			1/10/2025 2:09 PM
Details	Last Recertification Date	Insert	New Registration			1/10/2025 2:09 PM
Details	Grant Number	Insert	New Registration		H80CS00396	1/10/2025 2:09 PM
Details	340B ID	Insert	New Registration			1/10/2025 2:09 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/10/2025 2:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/10/2025 2:09 PM
Details	Medicare Provider Number	Insert	New Registration			1/10/2025 2:09 PM
Details	Entity Name	Insert	New Registration		FISH RIVER RURAL HEALTH	1/10/2025 2:09 PM
Details	NOFO Number	Insert	New Registration			1/10/2025 2:09 PM
Details	Program Code	Insert	New Registration		CH	1/10/2025 2:09 PM
Details	Entity Subname	Insert	New Registration		School-Based Health Center-Fort Kent High School	1/10/2025 2:09 PM
Dates	Participating Approval Date	Insert	New Registration			1/10/2025 2:09 PM
Details	State	Insert	New Registration		Pending	1/10/2025 2:09 PM
Dates	Registration Date	Insert	New Registration		1/10/2025 2:09:27 PM	1/10/2025 2:09 PM
Dates	Signed By Date	Insert	New Registration			1/10/2025 2:09 PM
Dates	Start Date	Insert	New Registration			1/10/2025 2:09 PM
Terminations	Termination Comments	Insert	New Registration			1/10/2025 2:09 PM
Terminations	Termination Date	Insert	New Registration			1/10/2025 2:09 PM
Terminations	Termination Effective Date	Insert	New Registration			1/10/2025 2:09 PM
Terminations	Termination Reason	Insert	New Registration			1/10/2025 2:09 PM

340B Drug Pricing Program Database