340B Drug Pricing Program Database

Pharmacy Name

CVS STATE CAPITAL, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00800
165 CAPITOL STREET
AUGUSTA, ME 04330

Pharmacy Comments

Approval Date

4/9/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2020
Pharmacy closed

Covered Entity Signing Official

Megan Evans, Medical Director
(207) 626-1051

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/9/2020