Contract Pharmacy Details

HANNAFORD BROS. CO., LLC
CAH201309-00 MRH Corp. DBA Northern Light Mayo Hospital

Covered Entity Details

Entity Name

MRH Corp. DBA Northern Light Mayo Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH201309-00

Entity Address

897 WEST MAIN STREET
DOVER FOXCROFT, ME 04426-1029

Medicare Provider Number

201309

Participating Start Date

9/22/2010

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

HANNAFORD BROS. CO., LLC

Pharmacy Address

DBA HANNAFORD SUPERMARKET & PHARMACY #84
37 CHURCH STREET
DEXTER, ME 04930

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jennifer Goodrich, Vice President of Finance
(207) 316-7189

Contract Pharmacy Representative

Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044

Signed By Date

7/15/2020

340B Drug Pricing Program Database