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WAL-MART PHARMACY 10-5076
CH014580 PENOBSCOT COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
Subdivision Name
BREWER MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH014580
Entity Address
735 WILSON ST
BREWER, ME 04412
Grant Number
H80CS04291
Participating Start Date
1/1/2005
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5076
Pharmacy Address
24 WALTON DR
BREWER, ME 04412
Pharmacy Comments
Contract Details
Approval Date
3/5/2012
Contract Begin Date
3/5/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ken Schmidt, CEO
(207) 945-5247 Ext: 401
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
2/24/2012
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