Contract Pharmacy Details

M DRUG LLC
SCH200050-00 MAINE COAST MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

MAINE COAST MEMORIAL HOSPITAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH200050-00

Entity Address

50 UNION STREET
ELLSWORTH, ME 04605

Medicare Provider Number

200050

Participating Start Date

4/1/2020

Last Recertification Date

9/9/2024

Entity Termination Date

7/1/2025

Pharmacy Details

Pharmacy Name

M DRUG LLC

Pharmacy Address

DBA NORTHERN LIGHT PHARMACY WHITING HILL
33 WHITING HILL RD STE 4
BREWER, ME 04412-1022

Pharmacy Comments

Contract Details

Approval Date

3/12/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Wendy J Jones, VP of Finance
(207) 374-3409

Contract Pharmacy Representative

Miller Drug
Matthew Marston, Senior Manager - Clinical Pharmacy Services
(207) 275-3327

Signed By Date

1/15/2020

340B Drug Pricing Program Database