Covered Entity Details

HV24741 MaineGeneral Medical Center (Active) - information as of 4/29/2025 11:55:28 PM

Main Details

Name

MaineGeneral Medical Center

Subdivision Name

Horizon Program

Type

Ryan White Part C

340B ID

HV24741

Grant Number

H76HA24741

Additional Details

Current Program Status

Active

Registration Date

10/8/2013

Participating Start Date

1/1/2014

Participating Approval Date

11/4/2013

Last Recertification Date

2/13/2025

Time Period the Assistance was Received

4/1/2022 - 3/31/2025

Contacts

Authorizing Official

MGH
Shane Gallagher, Manager/HIV and Harm Reduction Services
(207) 248-0477

Primary Contact

MaineGeneral Health-Horizon Program
Maia Pinksy, Medical Director
(207) 248-0460

Addresses

Street Address

21 Enterprise Drive
Augusta, ME 04330

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
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	Termination Date	Last Updated On
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024	07/01/2024		07/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/09/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/09/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK PUERTO RICO SPECIALTY PHARMACY,	CAREMARK PUERTO RICO SPECIALTY PHARMACY	6020 AVE ROBERTO SANCHEZ VILELLA	CAROLINA	PR	00982	07/14/2020	10/01/2020	07/15/2022	07/15/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/14/2020	10/01/2020		10/01/2020
Contract Detail	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	07/17/2014	10/01/2014	10/20/2020	10/22/2020
Contract Detail	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	12/10/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	CURANT HEALTH FLORIDA, LLC	11001 ROOSEVELT BLVD STE 1400		ST PETERSBURG	FL	33716-2338	04/01/2024	07/01/2024		07/01/2024
Contract Detail	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	07/17/2014	10/01/2014	10/20/2020	10/22/2020
Contract Detail	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	12/10/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	CURANT HEALTH GEORGIA LLC	CURANT HEALTH	200 TECHNOLOGY CT SE BLDG 200 SUITE B	SMYRNA	GA	30082-5250	10/05/2022	01/01/2023		01/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/12/2022	10/01/2022		10/01/2022
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/12/2022	10/01/2022		10/01/2022
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00800	165 CAPITOL STREET	AUGUSTA	ME	04330	04/09/2020	07/01/2020	04/01/2020	04/16/2020
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 04158	24 STONE ST., STE120	AUGUSTA	ME	04330	04/09/2020	07/01/2020		07/01/2020
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00620	1 KENNEDY MEMORIAL DR.	WATERVILLE	ME	04901	04/09/2020	07/01/2020		07/01/2020
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00273	446 SABATTUS ST.	LEWISTON	ME	04240	04/06/2021	07/01/2021		07/01/2021
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00374	449 FOREST AVENUE	PORTLAND	ME	04101	04/06/2021	07/01/2021		07/01/2021
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 02382	8 UNION STREET	AUBURN	ME	04210	04/06/2021	07/01/2021		07/01/2021
Contract Detail	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00806	51 MARKET STREET MILL CREEK S/C	SOUTH PORTLAND	ME	04106	10/05/2021	01/01/2022		01/01/2022
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/14/2020	10/01/2020		10/01/2020
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/09/2020	07/01/2020		07/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #48611	141 PREBLE STREET	PORTLAND	ME	04101	04/09/2020	07/01/2020		07/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2516	35 KNEELAND STREET	BOSTON	MA	02111	04/09/2020	07/01/2020		07/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/14/2020	10/01/2020		10/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/14/2020	10/01/2020		10/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/14/2020	10/01/2020		10/01/2020
Contract Detail	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	10/07/2024	01/01/2025		01/01/2025
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11373	403 WATER ST.	AUGUSTA	ME	04330	04/02/2020	07/01/2020	07/15/2022	07/15/2022
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17139	225 MADISON AVE	SKOWHEGAN	ME	04976-2054	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	RITE AID #04149	254 MAIN ST	BELFAST	ME	04915	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17484	19 MAIN ST	OAKLAND	ME	04963	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18411	3 HUDSON AVE	GUILFORD	ME	04443	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19285	9 SPRING ST	GARDINER	ME	04345	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19908	575 LISBON ST	LISBON FALLS	ME	04252	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19078	465 MAIN ST	WESTBROOK	ME	04092	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19464	290 CONGRESS ST STE 4	PORTLAND	ME	04101	10/13/2020	01/01/2021	10/20/2020	10/22/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17473	28 PARK ST	ROCKLAND	ME	04841-2816	10/13/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11742	226 HIGH STREET	ELLSWORTH	ME	04605-1742	10/13/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19802	430 SABATTUS ST	LEWISTON	ME	04240	10/13/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS #12400	868 MAIN ST.	SANFORD	ME	04073	10/13/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17356	317 MAIN STREET	FARMINGTON	ME	04938	10/13/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19188	77 MALLETT DR	TOPSHAM	ME	04086	10/13/2020	01/01/2021	07/15/2022	07/15/2022
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19886	223 TOWNSEND AVE	BOOTHBAY HARBOR	ME	04538	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11545	437 WILSON ST	BREWER	ME	04412	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18414	81 MAIN ST	LIVERMORE FALLS	ME	04254	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19397	61 UNION ST	AUBURN	ME	04210	10/13/2020	01/01/2021	12/01/2023	12/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19821	713 CONGRESS ST	PORTLAND	ME	04102	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #13615	268 MAIN ST	BELFAST	ME	04915	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19678	279 MAIN ST	SOUTH PORTLAND	ME	04106-2629	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10077	11 STATE ROAD	BATH	ME	04530-6014	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19359	2007 N BELFAST AVE	AUGUSTA	ME	04330	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17990	943 WESTERN AVE	MANCHESTER	ME	04351-3400	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10428	741 ROOSEVELT TRAIL	WINDHAM	ME	04062-5269	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18119	15 SACO AVE	OLD ORCHARD BEACH	ME	04064	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19902	665 ROOSEVELT TR. PO BOX 4008	NAPLES	ME	04055-5322	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18307	720 CENTRAL ST	MILLINOCKET	ME	04462	10/13/2020	01/01/2021	11/10/2020	01/28/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19162	698 MINOT AVE	AUBURN	ME	04210	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #12325	616 FOREST AVE	PORTLAND	ME	04101-1510	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11285	706 BROADWAY	BANGOR	ME	04401	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18416	123 MAIN ST	FAIRFIELD	ME	04937-1528	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #17136	315 MAIN STREET	LEWISTON	ME	04240	10/13/2020	01/01/2021	02/27/2024	04/08/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10988	233 U.S. ROUTE ONE	SCARBOROUGH	ME	04074	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11886	127 MARGINAL WAY STE 3	PORTLAND	ME	04101	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17745	16 PECK FARM RD	WINTHROP	ME	04364-1565	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19674	36 CHINA RD	WINSLOW	ME	04901	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17964	365 MAIN ST	DAMARISCOTTA	ME	04543	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11416	53 PARIS ST	NORWAY	ME	04268	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17156	210 MAIN ST	WATERVILLE	ME	04901	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19461	33 DEPOT RD	FALMOUTH	ME	04105	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18248	112 BENNETT DR	CARIBOU	ME	04736	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18409	335 ALFRED ST	BIDDEFORD	ME	04005	10/13/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19285	9 SPRING ST	GARDINER	ME	04345	10/05/2021	01/01/2022		01/01/2022
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	07/17/2023	10/01/2023		10/01/2023

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 12:00:17 PM	2/13/2025 2:32:59 PM	2/13/2025 2:32 PM
Contacts	Authorizing Official	Update	Change Request	McCarthy, Michele Grant Accounts Manager MaineGeneral Health 2078618665	Gallagher, Shane Manager/HIV and Harm Reduction Services MGH 2072480477	2/6/2025 2:08 PM
Details	Entity Name	Update	Change Request	Maine General Medical Center	MaineGeneral Medical Center	11/4/2024 10:31 AM
Contacts	Authorizing Official	Update	Change Request	LaPlante, Gillian Program Manager MaineGeneral Health 2072480460	McCarthy, Michele Grant Accounts Manager MaineGeneral Health 2078618665	10/25/2024 7:48 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 11:21:18 AM	1/29/2024 12:00:17 PM	1/29/2024 12:00 PM
Details	NOFO Number	Update		HRSA-18-092		12/16/2023 10:34 AM
Contacts	Authorizing Official	Update	Change Request	Pinksy, Maia Medical Director MaineGeneral Health-Horizon Program 2072480460	LaPlante, Gillian Program Manager MaineGeneral Health 2072480460	12/8/2023 2:23 PM
Contacts	Primary Contact	Update	Change Request	LaPlante, Gillian Program Manager MaineGeneral Health 2072480460	Pinksy, Maia Medical Director MaineGeneral Health-Horizon Program 2072480460	12/8/2023 2:23 PM
Contacts	Authorizing Official	Update	Change Request	Evans, Megan Medical Director Horizon Clinic 2076261051	Pinksy, Maia Medical Director MaineGeneral Health-Horizon Program 2072480460	11/16/2023 2:06 PM
Details	Assistance Received From Date	Update	Recertification	8/1/2012 12:00:00 AM	4/1/2022 12:00:00 AM	1/31/2023 11:21 AM
Details	Assistance Received To Date	Update	Recertification	3/31/2021 12:00:00 AM	3/31/2025 12:00:00 AM	1/31/2023 11:21 AM
Details	Last Recertification Date	Update	Recertification	2/8/2022 8:47:48 AM	1/31/2023 11:21:18 AM	1/31/2023 11:21 AM
Details	Last Recertification Date	Update	Recertification	2/16/2021 6:42:49 AM	2/8/2022 8:47:48 AM	2/8/2022 8:47 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1063716710 ( )		2/16/2021 6:42 AM
Contacts	Primary Contact	Update	Recertification	Frisch, Gillian Program Coordinator Horizon Clinic 2076213733	LaPlante, Gillian Program Manager MaineGeneral Health 2072480460	2/16/2021 6:42 AM
Details	Assistance Received From Date	Update	Recertification		8/1/2012 12:00:00 AM	2/16/2021 6:42 AM
Details	Assistance Received To Date	Update	Recertification		3/31/2021 12:00:00 AM	2/16/2021 6:42 AM
Details	Last Recertification Date	Update	Recertification	2/5/2020 12:50:48 PM	2/16/2021 6:42:49 AM	2/16/2021 6:42 AM
Details	NOFO Number	Update	Recertification		HRSA-18-092	2/16/2021 6:42 AM
Addresses	Shipping Address	Delete	Change Request	Horizon Clinic 150 Dresden Ave Gardiner, ME 04345		4/2/2020 2:32 PM
Addresses	Main Address	Update	Change Request	9 Green Street Augusta, ME 04330	21 Enterprise Drive Augusta, ME 04330	4/2/2020 2:32 PM
Details	Last Recertification Date	Update	Recertification	1/30/2019 11:29:16 AM	2/5/2020 12:50:48 PM	2/5/2020 12:50 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1063716710	9/3/2019 3:12 PM
Addresses	Shipping Address	Insert	Change Request		Horizon Clinic 150 Dresden Ave Gardiner, ME 04345	6/20/2019 9:41 AM
Details	Last Recertification Date	Update	Recertification	2/15/2018 8:27:39 AM	1/30/2019 11:29:16 AM	1/30/2019 11:29 AM
Contacts	Primary Contact	Update	Change Request	Wheelock, Francine Practice Administrator Maine General Health 2073145337	Frisch, Gillian Program Coordinator Horizon Clinic 2076213733	1/15/2019 10:22 AM
Contacts	Primary Contact	Update	Change Request	Karcher, Jennifer Program Director MaineGeneral Medical Center 2076213733	Wheelock, Francine Practice Administrator Maine General Health 2073145337	8/28/2018 4:33 PM
Details	Last Recertification Date	Update	Recertification	1/26/2017 12:00:00 AM	2/15/2018 8:27:39 AM	2/15/2018 8:27 AM
Contacts	Primary Contact	Update		Karcher, Jennifer Program Director 2076213733	Karcher, Jennifer Program Director MaineGeneral Medical Center 2076213733	11/9/2017 3:10 PM
Contacts	Authorizing Official	Update		Evans, Megan Medical Director 2076261051	Evans, Megan Medical Director Horizon Clinic 2076261051	9/30/2017 9:27 AM
Addresses	Main Address	Insert			9 Green Street Augusta, ME 04330	8/11/2017 7:49 AM
Contacts	Primary Contact	Update		Mamonova, Elena Program Director 2076213733	Karcher, Jennifer Program Director 2076213733	8/11/2017 7:49 AM
Contacts	Signed By	Insert			Rolfe, Mark Medical Director 2076261051	8/11/2017 7:49 AM
Contacts	Authorizing Official	Insert			Evans, Megan Medical Director 2076261051	8/11/2017 7:49 AM
Details	Last Recertification Date	Update		2/19/2016 12:00:00 AM	1/26/2017 12:00:00 AM	1/26/2017 8:43 AM
Details	Last Recertification Date	Update		3/3/2015 12:00:00 AM	2/19/2016 12:00:00 AM	2/19/2016 2:21 PM
Details	Last Recertification Date	Update		3/13/2014 12:00:00 AM	3/3/2015 12:00:00 AM	3/3/2015 3:32 PM
Contacts	Primary Contact	Insert			Mamonova, Elena Program Director 2076213733	3/13/2014 3:18 PM
Details	Last Recertification Date	Update			3/13/2014 12:00:00 AM	3/13/2014 3:18 PM
Dates	Participating Approval Date	Update			11/4/2013 12:00:00 AM	11/4/2013 10:54 AM
Details	State	Update		Pending	Active	11/4/2013 10:54 AM
Dates	Start Date	Update			1/1/2014 12:00:00 AM	11/4/2013 10:54 AM
Details	340B ID	Update		ONLINE_REG	HV24741	10/22/2013 10:45 AM
Details	Entity Name	Update		MaineGeneral Medical Center	Maine General Medical Center	10/22/2013 10:45 AM
Details	Last Recertification Date	Insert				10/8/2013 4:43 PM
Details	Grant Number	Insert			H76HA24741	10/8/2013 4:43 PM
Details	340B ID	Insert			ONLINE_REG	10/8/2013 4:43 PM
Details	Is Authorizing Official EHB Data	Insert				10/8/2013 4:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/8/2013 4:43 PM
Details	Medicare Provider Number	Insert				10/8/2013 4:43 PM
Details	Entity Name	Insert			MaineGeneral Medical Center	10/8/2013 4:43 PM
Details	Program Code	Insert			HV	10/8/2013 4:43 PM
Details	Entity Subname	Insert			Horizon Program	10/8/2013 4:43 PM
Dates	Participating Approval Date	Insert				10/8/2013 4:43 PM
Details	State	Insert			Pending	10/8/2013 4:43 PM
Dates	Registration Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 4:43 PM
Dates	Signed By Date	Insert			10/8/2013 12:00:00 AM	10/8/2013 4:43 PM
Dates	Start Date	Insert				10/8/2013 4:43 PM
Terminations	Termination Comments	Insert				10/8/2013 4:43 PM
Terminations	Termination Date	Insert				10/8/2013 4:43 PM
Terminations	Termination Effective Date	Insert				10/8/2013 4:43 PM
Terminations	Termination Reason	Insert				10/8/2013 4:43 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History