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RITE AID OF MAINE, INC.
DSH200063 PENOBSCOT BAY MEDICAL CENTER
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Covered Entity Details
Entity Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200063
Entity Address
6 Glen Cove Dr
Rockport, ME 04856
Medicare Provider Number
200063
Participating Start Date
4/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #4129
35 ELM STREET
CAMDEN, ME 04843
Pharmacy Comments
Contract Details
Approval Date
2/11/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2018
Ownership change
Contacts
Covered Entity Signing Official
MAURA KELLY, CFO
(207) 594-6721
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/10/2013
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