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CITY DRUG STORE
CHC08769-00 PINES HEALTH SERVICES
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Covered Entity Details
Entity Name
PINES HEALTH SERVICES
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CHC08769-00
Entity Address
74 ACCESS HIGHWAY
CARIBOU, ME 04736
Grant Number
H80CS08769
Participating Start Date
4/1/2009
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
CITY DRUG STORE
Pharmacy Address
159 ACADEMY ST
PRESQUE ISLE, ME 04769
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/2/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kris Doody, CEO
(207) 498-2356
Contract Pharmacy Representative
City Drug Store
Matt Talbot, VP and Pharmacist in Charge
(207) 764-4424
Signed By Date
10/15/2018
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