Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
DSH200009 MAINEHEALTH MAINE MEDICAL CENTER

Covered Entity Details

Entity Name

MAINEHEALTH MAINE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200009

Entity Address

22 BRAMHALL STREET
PORTLAND, ME 04102

Medicare Provider Number

200009

Participating Start Date

7/1/2011

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR, STE 1
BEAVERTON, OR 97008

Pharmacy Comments

Contract Details

Approval Date

7/19/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

Lugene Anthony Inzana, CFO
(207) 662-2654

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/19/2019

340B Drug Pricing Program Database