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CVS STATE CAPITAL, L.L.C.
HV24741 MaineGeneral Medical Center
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Covered Entity Details
Entity Name
MaineGeneral Medical Center
Subdivision Name
Horizon Program
Type
Ryan White Part C
340B ID
HV24741
Entity Address
21 Enterprise Drive
Augusta, ME 04330
Grant Number
H76HA24741
Participating Start Date
1/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00806
51 MARKET STREET
MILL CREEK S/C
SOUTH PORTLAND, ME 04106
Pharmacy Comments
Contract Details
Approval Date
10/5/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Megan Evans, Medical Director
(207) 626-1051
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/5/2021
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