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BEDARD PHARMACY, INC.
FQHCLA119 Community Clinical Services, Inc.
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Covered Entity Details
Entity Name
Community Clinical Services, Inc.
Subdivision Name
B Street Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA119
Entity Address
57 Birch Street
Lewiston, ME 04240-7415
Grant Number
LALCS00085
Participating Start Date
4/1/2001
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
BEDARD PHARMACY, INC.
Pharmacy Address
359 MINOT AVE STE B
AUBURN, ME 04210-4329
Pharmacy Comments
Contract Details
Approval Date
4/24/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JAMES LYSEN, EXECUTIVE DIRECTOR
(207) 513-3897
Contract Pharmacy Representative
Steven Royer, Vice President/COO
(207) 784-3700
Signed By Date
4/24/2014
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