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BANGOR DRUG LTC
CH014580 PENOBSCOT COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
Subdivision Name
BREWER MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH014580
Entity Address
735 WILSON ST
BREWER, ME 04412
Grant Number
H80CS04291
Participating Start Date
1/1/2005
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
BANGOR DRUG LTC
Pharmacy Address
711 BROADWAY STE 2
BANGOR, ME 04401-3225
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lorelle Dwyer, President & CEO
(207) 992-9200
Contract Pharmacy Representative
Bangor Drug LTC
Charles Ouellette, Owner
(207) 834-2880
Signed By Date
1/15/2020
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