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CAREMARK PUERTO RICO SPECIALTY PHARMACY,
HV24741 MaineGeneral Medical Center
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Covered Entity Details
Entity Name
MaineGeneral Medical Center
Subdivision Name
Horizon Program
Type
Ryan White Part C
340B ID
HV24741
Entity Address
21 Enterprise Drive
Augusta, ME 04330
Grant Number
H76HA24741
Participating Start Date
1/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
CAREMARK PUERTO RICO SPECIALTY PHARMACY,
Pharmacy Address
CAREMARK PUERTO RICO SPECIALTY PHARMACY
6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINA, PR 00982
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2022
Pharmacy closed
Contacts
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
7/14/2020
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