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CENTERWELL PHARMACY, INC.
DSH200009 MAINEHEALTH MAINE MEDICAL CENTER
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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
CENTERWELL PHARMACY, INC.
Pharmacy Address
9843 WINDISCH RD
WEST CHESTER, OH 45069
Pharmacy Comments
Contract Details
Approval Date
10/26/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lugene Anthony Inzana, CFO
(207) 662-2654
Contract Pharmacy Representative
Centerwell
Shelley Duke, Director, Specialty Pharmacy Contracting and Infusion
(502) 994-8732
Signed By Date
10/26/2020
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