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HANNAFORD BROS. CO., LLC
CAH201304-00 MOUNT DESERT ISLAND HOSPITAL
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Covered Entity Details
Entity Name
MOUNT DESERT ISLAND HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201304-00
Entity Address
10 WAYMAN LANE
BAR HARBOR, ME 04609
Medicare Provider Number
201304
Participating Start Date
9/29/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HANNAFORD BROS. CO., LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #82
86 COTTAGE STREET
BAR HARBOR, ME 04609
Pharmacy Comments
Contract Details
Approval Date
4/8/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina J. Maguire, President/CEO
(207) 288-5082 Ext: 1330
Contract Pharmacy Representative
Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044
Signed By Date
4/8/2019
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