Contract Pharmacy Details

CAREMARK, L.L.C.
DSH200009 MAINEHEALTH MAINE MEDICAL CENTER

Covered Entity Details

Entity Name

MAINEHEALTH MAINE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200009

Entity Address

22 BRAMHALL STREET
PORTLAND, ME 04102

Medicare Provider Number

200009

Participating Start Date

7/1/2011

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

CAREMARK, L.L.C.

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119

Pharmacy Comments

Contract Details

Approval Date

7/16/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lugene Anthony Inzana, CFO
(207) 662-2654

Contract Pharmacy Representative

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

Signed By Date

7/16/2020

340B Drug Pricing Program Database