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COMMUNITY PHARMACY OF NEWPORT
CH01517D SEBASTICOOK FAMILY DOCTORS
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Covered Entity Details
Entity Name
SEBASTICOOK FAMILY DOCTORS
Subdivision Name
FAMILY DOCTORS - CANAAN
Type
HRSA-Funded Health Center
340B ID
CH01517D
Entity Address
333 Main St
Canaan, ME 04924-3407
Grant Number
H80CS02448
Participating Start Date
7/1/2005
Last Recertification Date
2/5/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
COMMUNITY PHARMACY OF NEWPORT
Pharmacy Address
44 MOOSEHEAD TRAIL
NEWPORT, ME 04953
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
10/20/2005
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
5/27/2005
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