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WALGREEN EASTERN CO., INC.
DSH200039 MAINEGENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200039
Entity Address
35 Medical Center Parkway
Augusta, ME 04330
Medicare Provider Number
200039
Participating Start Date
7/1/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS SPECIALTY PHARMACY#10996
429 BROOKLINE AVENUE
BOSTON, MA 02215
Pharmacy Comments
Contract Details
Approval Date
1/12/2021
Contract Begin Date
2/4/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Terrance Brann, Chief Financial Officer
(207) 623-6624
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2021
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