Covered Entity Details

CH01046E HEALTHREACH COMMUNITY HEALTH CENTERS (Active) - information as of 4/24/2025 11:12:41 PM

Main Details

Name

HEALTHREACH COMMUNITY HEALTH CENTERS

Subdivision Name

MADISON AREA HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-002892

340B ID

CH01046E

Grant Number

H80CS00797

Additional Details

Current Program Status

Active

Registration Date

10/1/2001

Participating Start Date

10/1/2001

Participating Approval Date

10/21/2004

Last Recertification Date

2/17/2025

Contacts

Authorizing Official

HealthReach Community Health Centers
CONSTANCE COGGINS, CEO
(207) 872-5610

Primary Contact

Healthreach Community Health Centers
Donna Williams, Director of Finance
(207) 660-9912

Addresses

Street Address

8 S Main St
Madison, ME 04950-4501

Billing Address

HEALTHREACH COMMUNITY HEALTH CENTERS
10 WATER STREET
SUITE 305
WATERVILLE, ME 04901

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

Comments

Comment	Last Updated On
10/22/09 ADDED BILL TO; 9/22/09 UPDATED ADDR (WAS PO BOX 200); 10/21/04 UPDATED ENTITY NAME;10/21/04 REMOVED SHIP TO (WAS 30 CHASE AVE.; WATERVILLE; ME 04901)	01/08/2010
10/22/09 ADDED BILL TO; 9/22/09 UPDATED ADDR (WAS PO BOX 200); 10/21/04 UPDATED ENTITY NAME;10/21/04 REMOVED SHIP TO (WAS 30 CHASE AVE.; WATERVILLE; ME 04901)	01/08/2010

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	137970104	1184698441

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 RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	10/20/2011	08/09/2011		03/28/2013
Contract Detail	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	10/20/2011	07/08/2011		09/12/2013
Contract Detail	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	10/20/2011	07/08/2011		03/28/2013
Contract Detail	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	10/20/2011	07/08/2011		03/28/2013
Contract Detail	VARIETY DRUG	12 HIGH ST		SKOWHEGAN	ME	04976-1815	07/14/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	04/30/2012	05/03/2012		03/28/2013
Contract Detail	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	04/30/2012	05/04/2012		03/28/2013
Contract Detail	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	04/30/2012	05/04/2012		03/28/2013
Contract Detail	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	04/30/2012	05/04/2012		03/28/2013
Contract Detail	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/10/2011	11/18/2011		03/28/2013
Contract Detail	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	10/20/2011	07/08/2011	04/01/2021	04/05/2021

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH010460	Active	BPS-H80-005466	HEALTHREACH COMMUNITY HEALTH CENTERS	BINGHAM AREA HEALTH CENTER	237 Main St		Bingham	ME
CH01046B	Active	BPS-H80-004223	HEALTHREACH COMMUNITY HEALTH CENTERS	LOVEJOY HEALTH CENTER	7 SCHOOL STREET STE 1		ALBION	ME
CH01046C	Active	BPS-H80-002691	HEALTHREACH COMMUNITY HEALTH CENTERS	STRONG AREA HEALTH CENTER	177 N Main St		Strong	ME
CH01046D	Active	BPS-H80-001618	HEALTHREACH COMMUNITY HEALTH CENTERS	BELGRADE REGIONAL HEALTH CENTER	4 CLEMENT WAY		BELGRADE	ME
CH01046E	Active	BPS-H80-002892	HEALTHREACH COMMUNITY HEALTH CENTERS	MADISON AREA HEALTH CENTER	8 S Main St		Madison	ME
CH01046F	Active	BPS-H80-003608	HEALTHREACH COMMUNITY HEALTH CENTERS	RICHMOND AREA HEALTH CENTER	24 Gardiner St		Richmond	ME
CH01046G	Active	BPS-H80-000193	HEALTHREACH COMMUNITY HEALTH CENTERS	SHEEPSCOT VALLEY HEALTH CENTER	47 MAIN STREET		COOPERS MILLS	ME
CH01046I	Active	BPS-H80-012419	HEALTHREACH COMMUNITY HEALTH CENTERS	WESTERN MAINE FAMILY HEALTH CENTER	16 Depot Street	Ste 300	Livermore Falls	ME
CH01046J	Active	BPS-H80-004765	HEALTHREACH COMMUNITY HEALTH CENTERS	RANGELEY FAMILY MEDICINE	42 DALLAS HILL ROAD		RANGELEY	ME
CH01046L	Active	BPS-H80-002198	HEALTHREACH COMMUNITY HEALTH CENTERS	MT. ABRAM REGIONAL HEALTH CENTER	25 Depot St		Kingfield	ME
CH01046N	Active	BPS-H80-002780	HEALTHREACH COMMUNITY HEALTH CENTERS	BETHEL FAMILY HEALTH CENTER	32 Railroad St		Bethel	ME
CH01046P	Active	BPS-H80-033503	Healthreach Community Health Centers	Lawrence High School Health Center	9 School St		Fairfield	ME

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH010460	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/01/2024
CH010460	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/01/2025
CH010460	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	01/01/2025
CH010460	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	04/01/2025
CH010460	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2022
CH010460	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2022
CH010460	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2022
CH010460	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2022
CH010460	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2022
CH010460	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2022
CH010460	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2022
CH010460	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2022
CH010460	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2022
CH010460	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2022
CH01046L	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH01046G	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH010460	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH01046N	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH01046E	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH01046B	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH01046J	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH01046F	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	06/16/2011
CH01046C	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH01046D	COMMUNITY PHARMACY OF RANDOLPH	268 WATER ST		RANDOLPH	ME	04346-5217	08/09/2011
CH010460	COMMUNITY PHARMACY OF WALDOBORO	5 FRIENDSHIP ST		WALDOBORO	ME	04572-6287	10/01/2013
CH010460	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/01/2021
CH010460	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/01/2021
CH010460	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00620	1 KENNEDY MEMORIAL DR.	WATERVILLE	ME	04901	10/01/2015
CH010460	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 04158	24 STONE ST., STE120	AUGUSTA	ME	04330	10/01/2015
CH010460	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00273	446 SABATTUS ST.	LEWISTON	ME	04240	04/01/2021
CH010460	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00801	131 COURT STREET	BATH	ME	04530	04/01/2021
CH010460	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 02382	8 UNION STREET	AUBURN	ME	04210	04/01/2021
CH010460	CVS STATE CAPITAL, L.L.C.	CVS PHARMACY # 17382	119 CROSSING WAY	AUGUSTA	ME	04330	10/01/2021
CH010460	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00156	10 EAST AVE LEWISTON S/C	LEWISTON	ME	04240	04/01/2022
CH010460	CVS STATE CAPITAL, L.L.C.	CVS PHARMACY # 17213	125 TOPSHAM FAIR MALL RD	TOPSHAM	ME	04086	04/01/2022
CH01046D	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 00620	1 KENNEDY MEMORIAL DR.	WATERVILLE	ME	04901	10/01/2023
CH01046G	CVS STATE CAPITAL, L.L.C.	DBA: CVS/PHARMACY # 04158	24 STONE ST., STE120	AUGUSTA	ME	04330	10/01/2023
CH010460	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2022
CH010460	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/01/2022
CH01046L	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH01046G	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH010460	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH01046N	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH01046E	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH01046B	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/12/2010
CH01046J	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH01046F	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH01046C	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/08/2011
CH01046D	FAIRFIELD PHARMACY	66 WESTERN AVE		FAIRFIELD	ME	04937-1337	07/12/2010
CH010460	GARDINER APOTHECARY	GARDINER APOTHECARY, LLC	35 BRIDGE ST	GARDINER	ME	04345-1848	01/01/2018	05/31/2019
CH010460	GENOA HEALTHCARE LLC	841 RIVERSIDE DR STE P		AUGUSTA	ME	04330	04/01/2024
CH010460	GENOA HEALTHCARE LLC	2 SPRINGBROOK DR STE 101		BIDDEFORD	ME	04005	01/01/2025
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #81	15 JAY PLAZA LN	JAY	ME	04239	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	40 MAIN AVENUE	GARDINER	ME	04345	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	140 ELM PLAZA	WATERVILLE	ME	04901	10/01/2020	01/13/2025
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	190 JFK PLZ	WATERVILLE	ME	04901	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	29 WHITTEN ROAD	AUGUSTA	ME	04330	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	118 CONY STREET	AUGUSTA	ME	04330	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	33 HANNAFORD DRIVE	CHINA	ME	04358	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	399 MAIN STREET	WINTHROP	ME	04364	10/01/2020	04/01/2021
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	131 HANNAFORD DRIVE SUITE 1	FARMINGTON	ME	04938	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD FOOD & DRUG #8330	100 FAIRGROUNDS MARKETPLACE	SKOWHEGAN	ME	04976	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #83	1603 MAIN ST	OXFORD	ME	04270	10/01/2020
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD FOOD & DRUG #8358	520 WALDO ST	RUMFORD	ME	04276	10/01/2020	01/13/2025
CH010460	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #81	49 TOPSHAM FAIR MALL RD SUITE 1	TOPSHAM	ME	04086	07/01/2021	10/09/2022
CH01046B	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	33 HANNAFORD DRIVE	CHINA	ME	04358	10/01/2023
CH01046F	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	40 MAIN AVENUE	GARDINER	ME	04345	10/01/2023
CH01046G	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	33 HANNAFORD DRIVE	CHINA	ME	04358	10/01/2023
CH01046C	HANNAFORD BROS. CO., LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #82	131 HANNAFORD DRIVE SUITE 1	FARMINGTON	ME	04938	10/01/2023
CH010460	HOLLAND DRUG INC	MT BLUE DRUG	624 WILTON RD	FARMINGTON	ME	04938-6138	10/01/2021	10/12/2021
CH01046I	HOLLAND DRUG INC	MT BLUE DRUG	624 WILTON RD	FARMINGTON	ME	04938-6138	10/01/2023
CH010460	LEBLANC'S PHARMACY, LLC	D B A TAYLOR'S DRUG STORE	2 OLD POINT AVE	MADISON	ME	04950-1115	07/01/2017	07/02/2018
CH010460	MT BLUE DRUG INC	624 WILTON RD		FARMINGTON	ME	04938	01/01/2022
CH01046I	MT BLUE DRUG INC	624 WILTON RD		FARMINGTON	ME	04938	07/01/2024
CH01046L	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH01046G	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH010460	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH01046N	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH01046E	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH01046B	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/12/2010
CH01046J	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH01046F	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH01046C	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/08/2011
CH01046D	OAKLAND PHARMACY	43 MAIN ST.		OAKLAND	ME	04963	07/12/2010
CH010460	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	01/01/2025
CH010460	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	04/01/2024
CH010460	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2025
CH010460	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2025
CH010460	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/01/2024
CH010460	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2022
CH010460	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2022
CH010460	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2022
CH010460	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2022
CH010460	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #48611	141 PREBLE STREET	PORTLAND	ME	04101	07/01/2022
CH010460	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/01/2024
CH010460	RITE AID OF MAINE, INC.	RITE AID #3292	81 MAIN STREET	LIVERMORE FALLS	ME	04254	04/01/2013	01/18/2018
CH010460	RITE AID OF MAINE, INC.	RITE AID #4126	7 PORTLAND STREET	RUMFORD	ME	04276	04/01/2013	01/18/2018
CH010460	RITE AID OF MAINE, INC.	RITE AID #4944	28 MAYVILLE ROAD PO BOX 190	BETHEL	ME	04217	04/01/2013	01/18/2018
CH010460	RITE AID OF MAINE, INC.	RITE AID #4153	83 HOSPITAL STREET	AUGUSTA	ME	04330	04/01/2013	01/18/2018
CH010460	RITE AID OF MAINE, INC.	RITE AID #4143	36 CHINA ROAD	WINSLOW	ME	04901	04/01/2013	01/18/2018
CH010460	RITE AID OF MAINE, INC.	RITE AID #4123	317 MAIN STREET	FARMINGTON	ME	04938	04/01/2013	01/18/2018
CH010460	RITE AID OF MAINE, INC.	RITE AID #3308	2007 NORTH BELFAST AVENUE	AUGUSTA	ME	04330	04/01/2013	01/18/2018
CH010460	RITE AID OF MAINE, INC.	RITE AID #4168	9 SPRING STREET	GARDINER	ME	04345	04/01/2013	01/18/2018
CH010460	SHAWS SUPERMARKETS INC	SHAWS PHARMACY #2552	150 WESTERN AVE	AUGUSTA	ME	04330	10/01/2020	11/01/2024
CH010460	SPRUCE MOUNTAIN PHARMACY INC.	148 MAIN ST		JAY	ME	04239-1506	10/01/2019
CH010460	T&G, LLC DBA I CARE PHARMACY	227 MAIN ST.		FORT FAIRFIELD	ME	04742	07/01/2020	09/01/2024
CH01046L	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH01046G	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH010460	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH01046N	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH01046E	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH01046B	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/12/2010
CH01046J	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH01046F	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH01046C	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/08/2011
CH01046D	UNITY PHARMACY	33 PLAZA DRIVE, PO BOX 143		UNITY	ME	04988	07/12/2010
CH010460	VARIETY DRUG	12 HIGH ST		SKOWHEGAN	ME	04976-1815	10/01/2021
CH01046E	VARIETY DRUG	12 HIGH ST		SKOWHEGAN	ME	04976-1815	10/01/2023
CH010460	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2017
CH01046L	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH01046G	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH010460	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH01046N	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/24/2012
CH01046E	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH01046B	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH01046J	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH01046F	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH01046C	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH01046D	WAL-MART PHARMACY 10-1866	615 WILTON ROAD		FARMINGTON	ME	04938	05/03/2012
CH010460	WAL-MART PHARMACY 10-2013	80 WATERVILLE COMMONS DRIVE		WATERVILLE	ME	04901	07/01/2014
CH01046L	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046G	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH010460	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046N	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/24/2012
CH01046E	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046B	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046J	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046F	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046C	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046D	WAL-MART PHARMACY 10-2046	201 CIVIC CENTER DRIVE		AUGUSTA	ME	04330	05/04/2012
CH01046L	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046G	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH010460	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046N	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/24/2012
CH01046E	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046B	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046J	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046F	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046C	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046D	WAL-MART PHARMACY 10-2143	60 FAIRGROUNDS MARKET PLACE		SKOWHEGAN	ME	04976	05/04/2012
CH01046L	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH01046G	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH010460	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH01046N	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/24/2012
CH01046E	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH01046B	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH01046J	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH01046F	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH01046C	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH01046D	WAL-MART PHARMACY 10-2183	1240 MAIN STREET 1 RT.26		OXFORD	ME	04270	05/04/2012
CH010460	WAL-MART PHARMACY 10-3269	258 RIVER ROAD		MEXICO	ME	04257	07/01/2014
CH010460	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2020	04/05/2024
CH010460	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2017
CH010460	WALGREEN EASTERN CO., INC	WALGREENS #17355	66 MOOSEHEAD TRL	NEWPORT	ME	04953	01/01/2022
CH010460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11373	403 WATER ST.	AUGUSTA	ME	04330	01/01/2014	03/24/2025
CH010460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11416	53 PARIS ST	NORWAY	ME	04268	01/01/2014
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #19359	2007 N BELFAST AVE	AUGUSTA	ME	04330	02/05/2018
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #19575	28 MAYVILLE RD	BETHEL	ME	04217-4400	02/05/2018
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17356	317 MAIN STREET	FARMINGTON	ME	04938	02/05/2018
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #19674	36 CHINA RD	WINSLOW	ME	04901	02/05/2018
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17159	7 PORTLAND ST	RUMFORD	ME	04276	02/05/2018
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #18414	81 MAIN ST	LIVERMORE FALLS	ME	04254	02/05/2018
CH010460	WALGREEN EASTERN CO., INC.	RITE AID #04153	83 HOSPITAL ST	AUGUSTA	ME	04330	02/05/2018	09/30/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #19285	9 SPRING ST	GARDINER	ME	04345	02/05/2018
CH010460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #13615	268 MAIN ST	BELFAST	ME	04915	04/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17139	225 MADISON AVE	SKOWHEGAN	ME	04976-2054	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17332	420 SOMERSET AVE	PITTSFIELD	ME	04967	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17156	210 MAIN ST	WATERVILLE	ME	04901	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17484	19 MAIN ST	OAKLAND	ME	04963	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17745	16 PECK FARM RD	WINTHROP	ME	04364-1565	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17964	365 MAIN ST	DAMARISCOTTA	ME	04543	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #17990	943 WESTERN AVE	MANCHESTER	ME	04351-3400	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #18416	123 MAIN ST	FAIRFIELD	ME	04937-1528	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	WALGREENS #19188	77 MALLETT DR	TOPSHAM	ME	04086	07/01/2019
CH010460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10077	11 STATE ROAD	BATH	ME	04530-6014	01/01/2022
CH010460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19162	698 MINOT AVE	AUBURN	ME	04210	01/01/2022
CH010460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19802	430 SABATTUS ST	LEWISTON	ME	04240	01/01/2022
CH010460	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #19908	575 LISBON ST	LISBON FALLS	ME	04252	01/01/2022
CH01046N	WALGREEN EASTERN CO., INC.	WALGREENS #19575	28 MAYVILLE RD	BETHEL	ME	04217-4400	10/01/2023
CH010460	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	07/01/2023
CH010460	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	01/01/2014	07/10/2015
CH010460	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/01/2022
CH010460	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/01/2022
CH010460	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/01/2022
CH010460	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH010460	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	07/01/2024
CH01046L	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	10/24/2011
CH01046G	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH010460	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046N	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046E	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046B	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046J	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046F	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046C	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046D	WESTERN MAINE PHARMACY, INC.	WESTERN MAINE PHARMACY	119 MAIN ST	KINGFIELD	ME	04947	11/18/2011
CH01046L	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/08/2011	04/01/2021
CH01046G	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/12/2010	04/01/2021
CH010460	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/08/2011	04/01/2021
CH01046N	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/08/2011	04/01/2021
CH01046E	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/08/2011	04/01/2021
CH01046B	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/12/2010	04/01/2021
CH01046J	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/08/2011	04/01/2021
CH01046F	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/08/2011	04/01/2021
CH01046C	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/08/2011	04/01/2021
CH01046D	WINSLOW PHARMACY (DBA)	WINSLOW RX (CORP. NAME)	20 GARLAND ROAD	WINSLOW	ME	04901	07/12/2010	04/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/7/2024 7:50:22 AM	2/17/2025 7:35:41 AM	2/17/2025 7:35 AM
Details	Last Recertification Date	Update	Recertification	2/13/2023 7:41:45 AM	2/7/2024 7:50:22 AM	2/7/2024 7:50 AM
Contacts	Primary Contact	Update	PC Change Request	WILLIAMS, DONNA DIRECTOR OF FINANCE HEALTHREACH COMMUNITY HEALTH CENTERS 2078725610	Williams, Donna Director of Finance Healthreach Community Health Centers 2076609912	5/31/2023 9:35 AM
Details	Last Recertification Date	Update	Recertification	2/3/2022 10:04:28 AM	2/13/2023 7:41:45 AM	2/13/2023 7:41 AM
Details	Last Recertification Date	Update	Recertification	2/9/2021 9:33:18 AM	2/3/2022 10:04:28 AM	2/3/2022 10:04 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1184698441	2/9/2021 9:33 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	2/9/2021 9:33 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1184698441 ( )		2/9/2021 9:33 AM
Details	Last Recertification Date	Update	Recertification	2/4/2020 3:27:39 PM	2/9/2021 9:33:18 AM	2/9/2021 9:33 AM
Details	Last Recertification Date	Update	Recertification	2/7/2019 9:12:18 AM	2/4/2020 3:27:39 PM	2/4/2020 3:27 PM
Details	Last Recertification Date	Update	Recertification	3/2/2018 9:46:37 AM	2/7/2019 9:12:18 AM	2/7/2019 9:12 AM
Contacts	Primary Contact	Update	Recertification	WILLIAMS, DONNA ACCOUNTING AND ANALYTICS MGR HEALTHREACH COMMUNITY HEALTH CENTERS 2078725610	WILLIAMS, DONNA DIRECTOR OF FINANCE HEALTHREACH COMMUNITY HEALTH CENTERS 2078725610	2/7/2019 9:07 AM
Details	Last Recertification Date	Update	Recertification	2/10/2017 12:00:00 AM	3/2/2018 9:46:37 AM	3/2/2018 9:46 AM
Contacts	Primary Contact	Update	Recertification	COGGINS, CONSTANCE CEO 2078725610	WILLIAMS, DONNA ACCOUNTING AND ANALYTICS MGR HEALTHREACH COMMUNITY HEALTH CENTERS 2078725610	3/2/2018 9:39 AM
Contacts	Authorizing Official	Update		COGGINS, CONSTANCE CEO 2078725610	COGGINS, CONSTANCE CEO HealthReach Community Health Centers 2078725610	10/3/2017 7:14 AM
Contacts	Authorizing Official	Insert			COGGINS, CONSTANCE CEO 2078725610	4/11/2017 11:38 AM
Addresses	Main Address	Insert			8 S Main St Madison, ME 04950-4501	2/10/2017 7:59 AM
Contacts	Primary Contact	Insert			COGGINS, CONSTANCE CEO 2078725610	2/10/2017 7:59 AM
Details	Last Recertification Date	Update		2/18/2016 12:00:00 AM	2/10/2017 12:00:00 AM	2/10/2017 7:59 AM
Addresses	Billing Address	Insert			HEALTHREACH COMMUNITY HEALTH CENTERS 10 WATER STREET SUITE 305 WATERVILLE, ME 04901	11/16/2016 7:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/16/2016 7:53 AM
Medicaid Billing	Medicaid: Number	Insert			137970104	11/16/2016 7:53 AM
Medicaid Billing	Medicaid: State	Insert			ME	11/16/2016 7:53 AM
Medicaid Billing	NPI: Number	Insert			1184698441	11/16/2016 7:53 AM
Details	Last Recertification Date	Update		2/10/2015 12:00:00 AM	2/18/2016 12:00:00 AM	2/18/2016 2:10 PM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	2/10/2015 12:00:00 AM	2/10/2015 12:12 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/10/2014 12:00:00 AM	2/10/2014 9:50 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/11/2013 8:31 AM
Details	Last Recertification Date	Insert				1/8/2010 12:29 PM
Details	Grant Number	Insert			H80CS00797	1/8/2010 12:29 PM
Details	340B ID	Insert			CH01046E	1/8/2010 12:29 PM
Details	Is Authorizing Official EHB Data	Insert				1/8/2010 12:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2010 12:29 PM
Details	Medicare Provider Number	Insert				1/8/2010 12:29 PM
Details	Entity Name	Insert			HEALTHREACH COMMUNITY HEALTH CENTERS	1/8/2010 12:29 PM
Details	Program Code	Insert			CH	1/8/2010 12:29 PM
Details	Entity Subname	Insert			MADISON AREA HEALTH CENTER	1/8/2010 12:29 PM
Dates	Participating Approval Date	Insert			10/21/2004 12:00:00 AM	1/8/2010 12:29 PM
Details	State	Insert			Active	1/8/2010 12:29 PM
Dates	Registration Date	Insert			10/1/2001 12:00:00 AM	1/8/2010 12:29 PM
Dates	Signed By Date	Insert				1/8/2010 12:29 PM
Dates	Start Date	Insert			10/1/2001 12:00:00 AM	1/8/2010 12:29 PM
Terminations	Termination Comments	Insert				1/8/2010 12:29 PM
Terminations	Termination Date	Insert				1/8/2010 12:29 PM
Terminations	Termination Effective Date	Insert				1/8/2010 12:29 PM
Terminations	Termination Reason	Insert				1/8/2010 12:29 PM
Details	Comments Public	Insert			10/22/09 ADDED BILL TO; 9/22/09 UPDATED ADDR (WAS PO BOX 200); 10/21/04 UPDATED ENTITY NAME;10/21/04 REMOVED SHIP TO (WAS 30 CHASE AVE.; WATERVILLE; ME 04901)	1/8/2010 12:29 PM
Details	Comments Public	Insert			10/22/09 ADDED BILL TO; 9/22/09 UPDATED ADDR (WAS PO BOX 200); 10/21/04 UPDATED ENTITY NAME;10/21/04 REMOVED SHIP TO (WAS 30 CHASE AVE.; WATERVILLE; ME 04901)	1/8/2010 12:29 PM

340B Drug Pricing Program Database