Contract Pharmacy Details

HANNAFORD BROS. CO., LLC
DSH200063 PENOBSCOT BAY MEDICAL CENTER

Covered Entity Details

Entity Name

PENOBSCOT BAY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200063

Entity Address

6 Glen Cove Dr
Rockport, ME 04856

Medicare Provider Number

200063

Participating Start Date

4/1/2006

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

HANNAFORD BROS. CO., LLC

Pharmacy Address

DBA HANNAFORD SUPERMARKET & PHARMACY #82
33 HANNAFORD DRIVE
CHINA, ME 04358

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

Linda Drinkwater, CFO
(207) 505-4104

Contract Pharmacy Representative

Hannaford
Mike Fish, Pharmacy District Manager
(518) 428-2712

Signed By Date

7/16/2020

340B Drug Pricing Program Database