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CVS STATE CAPITAL, L.L.C.
CHC25680-00 PORTLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PORTLAND COMMUNITY HEALTH CENTER
Subdivision Name
Greater Portland Health at 180 Park Avenue
Type
HRSA-Funded Health Center
340B ID
CHC25680-00
Entity Address
180 Park Ave
Portland, ME 04102-2957
Grant Number
H80CS25680
Participating Start Date
10/1/2013
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00805
335 OCEAN HOUSE ROAD
CAPE ELIZABETH, ME 04107
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2018
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