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Red Chip of Nevada
HM04074 Maine Medical Center
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Covered Entity Details
Entity Name
Maine Medical Center
Subdivision Name
Maine Children's Cancer Program
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM04074
Entity Address
100 Campus Drive
107
Scarborough, ME 04074
Grant Number
H30MC24048
Participating Start Date
1/1/2020
Last Recertification Date
2/23/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
Red Chip of Nevada
Pharmacy Address
18009 Sky Park Circle, Suite G
Irvine, CA 92614
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lugene Anthony Inzana, CFO
(207) 662-2654
Contract Pharmacy Representative
Red Chip of Nevada
Chad Geary, Director of Operations
(949) 476-6361
Signed By Date
1/10/2020
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