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HANNAFORD BROS. CO., LLC
CAH201314-00 REDINGTON-FAIRVIEW GENERAL HOSPITAL
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Covered Entity Details
Entity Name
REDINGTON-FAIRVIEW GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201314-00
Entity Address
46 FAIRVIEW AVE
SKOWHEGAN, ME 04976
Medicare Provider Number
201314
Participating Start Date
4/1/2011
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
HANNAFORD BROS. CO., LLC
Pharmacy Address
DBA SUPERMARKET & PHARMACY #8443
44 MOOSEHEAD TRAIL
NEWPORT, ME 04953
Pharmacy Comments
Contract Details
Approval Date
2/3/2021
Contract Begin Date
2/16/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ELMER DOUCETTE, CHIEF FINANCIAL OFFICER
(207) 858-2176
Contract Pharmacy Representative
Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044
Signed By Date
2/3/2021
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