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CVS STATE CAPITAL, L.L.C.
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
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04158
24 STONE ST., STE120
AUGUSTA, ME 04330
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laurie Kane-Lewis, CEO
(207) 524-4001
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2019
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