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COMMUNITY PHARMACY OF RANDOLPH
CH01046L HEALTHREACH COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
HEALTHREACH COMMUNITY HEALTH CENTERS
Subdivision Name
MT. ABRAM REGIONAL HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH01046L
Entity Address
25 Depot St
Kingfield, ME 04947-4208
Grant Number
H80CS00797
Participating Start Date
10/1/2001
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
COMMUNITY PHARMACY OF RANDOLPH
Pharmacy Address
268 WATER ST
RANDOLPH, ME 04346-5217
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
8/9/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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