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CVS STATE CAPITAL, L.L.C.
DSH200034 St. Mary's Regional Medical Center
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Covered Entity Details
Entity Name
St. Mary's Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200034
Entity Address
93 Campus Avenue
Lewiston, ME 04240-6030
Medicare Provider Number
200034
Participating Start Date
10/1/2002
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00801
131 COURT STREET
BATH, ME 04530
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Hendrix, CFO/Treasurer
(207) 777-8865
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2019
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