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KMART PHARMACY #3021
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
KMART PHARMACY #3021
Pharmacy Address
603 CENTER STREET
AUBURN, ME 04210
Pharmacy Comments
Contract Details
Approval Date
1/16/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Joan Churchill, EXECUTIVE DIRECTOR/CFO
(207) 513-3897
Contract Pharmacy Representative
Business Finance Pharmacy
Bhumi Patel, Manager
(847) 286-7865
Signed By Date
1/16/2019
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