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HANNAFORD BROS. CO., LLC
CAH201310-00 BRIDGTON HOSPITAL
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Covered Entity Details
Entity Name
BRIDGTON HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201310-00
Entity Address
10 HOSPITAL DRIVE
BRIDGTON, ME 04009
Medicare Provider Number
201310
Participating Start Date
8/31/2010
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
HANNAFORD BROS. CO., LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #81
49 TOPSHAM FAIR MALL RD
SUITE 1
TOPSHAM, ME 04086
Pharmacy Comments
Contract Details
Approval Date
7/27/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/19/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Whitlock, CFO
(207) 795-2813
Contract Pharmacy Representative
Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044
Signed By Date
7/27/2020
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