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MAINEHEALTH
CAH201315-00 MAINEHEALTH STEPHENS HOSPITAL
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Covered Entity Details
Entity Name
MAINEHEALTH STEPHENS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201315-00
Entity Address
181 Main Street
Norway, ME 04268
Medicare Provider Number
201315
Participating Start Date
1/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
MAINEHEALTH
Pharmacy Address
MAINEHEALTH PHARMACY MAINE MEDICAL CENTE
22 BRAMHALL ST
PORTLAND, ME 04102
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John W. Cox, Chief Financial Officer
(207) 744-6024
Contract Pharmacy Representative
Maine Medical Center
Andrea Lai, Director of Ambulatory Care Pharmacy Services
(207) 662-5366
Signed By Date
10/14/2021
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