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CITY DRUG STORE
DSH200018 THE AROOSTOOK MEDICAL CENTER
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Covered Entity Details
Entity Name
THE AROOSTOOK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200018
Entity Address
140 ACADEMY STREET
PRESQUE ISLE, ME 04769
Medicare Provider Number
200018
Participating Start Date
7/1/2016
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
CITY DRUG STORE
Pharmacy Address
159 ACADEMY ST
PRESQUE ISLE, ME 04769
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maura Kelly, CFO
(207) 768-4737
Contract Pharmacy Representative
City Drug Store
Matt Talbot, VP and Pharmacist in Charge
(207) 764-4424
Signed By Date
1/11/2019
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