Contract Pharmacy Details

RITE AID OF MAINE, INC.
FQHCLA119 Community Clinical Services, Inc.

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

RITE AID OF MAINE, INC.

Pharmacy Address

RITE AID #3300
315 MAIN STREET
LEWISTON, ME 04240

Pharmacy Comments

Contract Details

Approval Date

7/7/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/29/2017
Ownership change

Contacts

Covered Entity Signing Official

JAMES LYSEN, EXECUTIVE DIRECTOR
(207) 513-3897

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

7/7/2014

340B Drug Pricing Program Database