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APOTHECARY RX
FQHCLA119M Community Clinical Services, Inc.
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Covered Entity Details
Entity Name
Community Clinical Services, Inc.
Subdivision Name
Lewiston High School-Based Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA119M
Entity Address
156 East Avenue
Lewiston, ME 04240-5626
Grant Number
LALCS00085
Participating Start Date
10/1/2004
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
APOTHECARY RX
Pharmacy Address
THE MEDICINE SHOPPE
373 SABATTUS ST
LEWISTON, ME 04240
Pharmacy Comments
Contract Details
Approval Date
10/11/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
JAMES LYSEN, EXECUTIVE DIRECTOR
(207) 513-3897
Contract Pharmacy Representative
LANA HOANG, OWNER/MANAGER
(207) 783-3539
Signed By Date
10/11/2013
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