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MAINEHEALTH
CAH201312-00 MAINEHEALTH WALDO HOSPITAL
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Covered Entity Details
Entity Name
MAINEHEALTH WALDO HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201312-00
Entity Address
118 NORTHPORT AVENUE
BELFAST, ME 04915
Medicare Provider Number
201312
Participating Start Date
9/9/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MAINEHEALTH
Pharmacy Address
DBA MAINEHEALTH PHARMACY PEN BAY HOSPITA
6 GLEN COVE DR
ROCKPORT, ME 04856
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Linda Drinkwater, CFO
(207) 505-4104
Contract Pharmacy Representative
Waldo County General Hospital
David MacMillan, Director of Pharmacy
(207) 301-8563
Signed By Date
1/14/2019
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