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WALGREEN EASTERN CO., INC.
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
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #19908
575 LISBON ST
LISBON FALLS, ME 04252
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laurie Kane-Lewis, CEO
(207) 524-4001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2019
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