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WAL-MART PHARMACY 10-1868
CH013280 D.F.D. RUSSELL MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
D.F.D. RUSSELL MEDICAL CENTER, INC.
Subdivision Name
DFD RUSSELL MEDICAL CENTER - LEEDS
Type
HRSA-Funded Health Center
340B ID
CH013280
Entity Address
180 Church Hill Rd
Leeds, ME 04263-3418
Grant Number
H80CS00642
Participating Start Date
1/1/2001
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1868
Pharmacy Address
100 MT AUBURN AVE
AUBURN, ME 04210
Pharmacy Comments
Contract Details
Approval Date
3/5/2012
Contract Begin Date
3/5/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL P. PAYNE, CHIEF FINANCIAL OFFICER
(207) 524-4003 Ext: 299
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
2/24/2012
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