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WAL-MART PHARMACY 10-2047
CH01517B SEBASTICOOK FAMILY DOCTORS
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Covered Entity Details
Entity Name
SEBASTICOOK FAMILY DOCTORS
Subdivision Name
Sebasticook Family Doctors
Type
HRSA-Funded Health Center
340B ID
CH01517B
Entity Address
118 MOOSEHEAD TRAIL
STE 5
NEWPORT, ME 04953
Grant Number
H80CS02448
Participating Start Date
7/1/2005
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2047
Pharmacy Address
1573 MAIN STREET
PALMYRA, ME 04965
Pharmacy Comments
Contract Details
Approval Date
4/2/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robin Winslow, CEO
(207) 368-4213
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/2/2015
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