Covered Entity Details

CAH201313-00 Sebasticook Valley Health (Active) - information as of 4/29/2025 11:56:37 PM

Main Details

Name

Sebasticook Valley Health

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH201313-00

Medicare Provider Number

201313

Additional Details

Current Program Status

Active

Registration Date

4/5/2011

Participating Start Date

7/1/2011

Participating Approval Date

4/27/2011

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

Sebasticook Valley Health
RANDALL CLARK, PRESIDENT
(207) 487-4022

Primary Contact

Sebasticook Valley Hospital
Derek Micheal Nadeau, Director of Pharmacy and Infusion
(207) 487-4007

Addresses

Street Address

447 NORTH MAIN STREET
PITTSFIELD, ME 04967

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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?
Yes

State	Medicaid Number	NPI Number
ME		1063617744,1457461477

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	COMMUNITY PHARMACY OF NEWPORT		44 MOOSEHEAD TRAIL	NEWPORT	ME	04953	04/15/2014	07/01/2014	12/29/2016	12/30/2016
Contract Detail	HANNAFORD BROS. CO., LLC	DBA SUPERMARKET & PHARMACY #8443	44 MOOSEHEAD TRAIL	NEWPORT	ME	04953	07/14/2020	10/01/2020		10/01/2020
Contract Detail	M DRUG LLC	DBA NORTHERN LIGHT PHARMACY	70 BENNETT ST	BANGOR	ME	04401	01/23/2015	04/01/2015		01/23/2015
Contract Detail	M DRUG LLC	DBA NORTHERN LIGHT PHARMACY WHITING HILL	33 WHITING HILL RD STE 4	BREWER	ME	04412-1022	04/11/2019	07/01/2019		07/01/2019
Contract Detail	RITE AID OF MAINE, INC.	RITE AID #4142	506 SOMERSET AVENUE	PITTSFIELD	ME	04967	04/17/2013	07/01/2013	01/25/2018	04/26/2018
Contract Detail	RITE AID OF MAINE, INC.	RITE AID #3299	36 MOOSEHEAD TRAIL	NEWPORT	ME	04953	04/17/2013	07/01/2013	01/25/2018	04/26/2018
Contract Detail	RITE AID OF MAINE, INC.	RITE AID #3294	188 SPRING STREET	DEXTER	ME	04930	04/17/2013	07/01/2013	01/25/2018	04/26/2018
Contract Detail	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	10/28/2014	01/01/2015	09/01/2016	09/21/2016
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/14/2020	10/01/2020		10/01/2020
Contract Detail	WAL-MART PHARMACY 10-2047	1573 MAIN STREET		PALMYRA	ME	04965	04/18/2014	07/01/2014		04/18/2014
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/14/2020	10/01/2020		10/01/2020
Contract Detail	WALGREEN EASTERN CO., INC	WALGREENS #17355	66 MOOSEHEAD TRL	NEWPORT	ME	04953	01/31/2018	02/07/2018		02/07/2018
Contract Detail	WALGREEN EASTERN CO., INC.	RITE AID #03294	188 SPRING ST	DEXTER	ME	04930	01/31/2018	02/07/2018	05/20/2019	06/04/2019
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17332	420 SOMERSET AVE	PITTSFIELD	ME	04967	01/31/2018	02/07/2018		02/07/2018
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/15/2025	07/01/2025		04/15/2025
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/11/2023	07/01/2023		07/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH201313-01	Child	CAH	Sebasticook Valley Health	SVH FAMILY CARE	1309 MAIN ST.	CLINTON	ME	Active
CAH201313-02	Child	CAH	Sebasticook Valley Health	SVH FAMILY CARE	8 MAIN STREET	NEWPORT	ME	Active
CAH201313-03	Child	CAH	Sebasticook Valley Health	SVH FAMILY CARE	470 SOMERSET AVE.	PITTSFIELD	ME	Active
CAH201313-04	Child	CAH	Sebasticook Valley Health	SVH SPECIALTY SERVICES	425 North Main Street	Pittsfield	ME	Active
CAH201313-05	Child	CAH	Sebasticook Valley Health	Northern Light Health Center-Newport Plaza - Primary Care	26 Main Street	Newport	ME	Active
CAH201313-06	Child	CAH	Sebasticook Valley Health	Northern Light General Surgery - General Surgery	425 North Main Street	Pittsfield	ME	Active
CAH201313-07	Child	CAH	Sebasticook Valley Health	Northern Light OB/GYN - OB/GYN	425 North Main Street	Pittsfield	ME	Active
CAH201313-08	Child	CAH	Sebasticook Valley Health	Northern Light Urology - Urology	425 North Main Street	Pittsfield	ME	Active
CAH201313-09	Child	CAH	Sebasticook Valley Health	NORTHERN LIGHT GASTROENTEROLOGY - GASTROENTEROLOGY	425 North Main Street	Pittsfield	ME	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Recertification	Adams, Sarah Ashley Director of Pharmacy Sebasticook Valley Hospital 2074874007	Nadeau, Derek Micheal Director of Pharmacy and Infusion Sebasticook Valley Hospital 2074874007	9/9/2024 3:36 PM
Details	Last Recertification Date	Update	Recertification	9/5/2023 4:24:53 PM	9/9/2024 3:36:46 PM	9/9/2024 3:36 PM
Details	Last Recertification Date	Update	Recertification	9/6/2022 11:02:49 AM	9/5/2023 4:24:53 PM	9/5/2023 4:24 PM
Contacts	Primary Contact	Update	Group Change Request	THORNTON, TYSON James DIRECTOR OF PHARMACY Sebasticook Valley Health 2074874089	Adams, Sarah Ashley Director of Pharmacy Sebasticook Valley Hospital 2074874007	8/1/2023 2:04 PM
Contacts	Authorizing Official	Update	Profile Change Request	CLARK, RANDALL CHIEF FINANCIAL OFFICER Sebasticook Valley Health 2074874022	CLARK, RANDALL PRESIDENT Sebasticook Valley Health 2074874022	1/30/2023 3:18 PM
Details	Last Recertification Date	Update	Recertification	8/31/2021 11:09:17 AM	9/6/2022 11:02:49 AM	9/6/2022 11:02 AM
Details	Last Recertification Date	Update	Recertification	9/3/2020 8:11:16 AM	8/31/2021 11:09:17 AM	8/31/2021 11:09 AM
Medicaid Billing	NPI: State	Update	Recertification		ME	9/3/2020 8:11 AM
Medicaid Billing	NPI: State	Update	Recertification		ME	9/3/2020 8:11 AM
Details	Last Recertification Date	Update	Recertification	8/27/2019 4:17:24 PM	9/3/2020 8:11:16 AM	9/3/2020 8:11 AM
Details	Last Recertification Date	Update	Recertification	8/30/2018 12:53:29 PM	8/27/2019 4:17:24 PM	8/27/2019 4:17 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 11:33:16 AM	8/30/2018 12:53:29 PM	8/30/2018 12:53 PM
Details	Last Recertification Date	Update	Recertification	8/18/2016 12:00:00 AM	11/29/2017 11:33:16 AM	11/29/2017 11:33 AM
Contacts	Authorizing Official	Update		CLARK, RANDALL CHIEF FINANCIAL OFFICER 2074874022	CLARK, RANDALL CHIEF FINANCIAL OFFICER Sebasticook Valley Health 2074874022	10/11/2017 8:26 AM
Contacts	Primary Contact	Update		THORNTON, TYSON DIRECTOR OF PHARMACY 2074874089	THORNTON, TYSON James DIRECTOR OF PHARMACY Sebasticook Valley Health 2074874089	9/26/2017 2:55 PM
Contacts	Authorizing Official	Insert			CLARK, RANDALL CHIEF FINANCIAL OFFICER 2074874022	12/30/2016 10:06 AM
Contacts	Primary Contact	Insert			THORNTON, TYSON DIRECTOR OF PHARMACY 2074874089	8/19/2016 7:37 AM
Addresses	Main Address	Insert			447 NORTH MAIN STREET PITTSFIELD, ME 04967	8/18/2016 5:56 PM
Details	Last Recertification Date	Update		9/3/2015 12:00:00 AM	8/18/2016 12:00:00 AM	8/18/2016 5:56 PM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	9/3/2015 12:00:00 AM	9/4/2015 9:38 AM
Details	Entity Name	Update		SEBASTICOOK VALLEY HOSPITAL ASSOCIATES DBA SEBASTICOOK VALLEY HEALTH	Sebasticook Valley Health	8/26/2014 9:53 AM
Details	Last Recertification Date	Update		9/13/2013 12:00:00 AM	8/21/2014 12:00:00 AM	8/21/2014 11:52 AM
Details	Last Recertification Date	Update			9/13/2013 12:00:00 AM	9/13/2013 2:18 PM
Details	Last Recertification Date	Insert				6/17/2011 9:27 AM
Details	Grant Number	Insert				6/17/2011 9:27 AM
Details	340B ID	Insert			CAH201313-00	6/17/2011 9:27 AM
Details	Is Authorizing Official EHB Data	Insert				6/17/2011 9:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert				6/17/2011 9:27 AM
Details	Medicare Provider Number	Insert			201313	6/17/2011 9:27 AM
Details	Entity Name	Insert			SEBASTICOOK VALLEY HOSPITAL ASSOCIATES DBA SEBASTICOOK VALLEY HEALTH	6/17/2011 9:27 AM
Details	Program Code	Insert			CAH	6/17/2011 9:27 AM
Details	Entity Subname	Insert				6/17/2011 9:27 AM
Dates	Participating Approval Date	Insert			4/27/2011 12:00:00 AM	6/17/2011 9:27 AM
Details	State	Insert			Active	6/17/2011 9:27 AM
Dates	Registration Date	Insert			4/5/2011 12:00:00 AM	6/17/2011 9:27 AM
Dates	Signed By Date	Insert			5/27/2011 12:00:00 AM	6/17/2011 9:27 AM
Dates	Start Date	Insert			7/1/2011 12:00:00 AM	6/17/2011 9:27 AM
Terminations	Termination Comments	Insert				6/17/2011 9:27 AM
Terminations	Termination Date	Insert				6/17/2011 9:27 AM
Terminations	Termination Effective Date	Insert				6/17/2011 9:27 AM
Terminations	Termination Reason	Insert				6/17/2011 9:27 AM
Medicaid Billing	NPI: Number	Insert			1457461477	4/5/2011 12:56 PM
Medicaid Billing	NPI: Number	Insert			1063617744	4/5/2011 12:56 PM