Contract Pharmacy Details

Red Chip of Nevada
HM040741 Maine Medical Center

Covered Entity Details

Entity Name

Maine Medical Center

Subdivision Name

Maine Medical Center Out Patient Care

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM040741

Entity Address

100 Campus Drive
suite 121
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