Contract Pharmacy Details

CVS STATE CAPITAL, L.L.C.
CHC25680-00 PORTLAND COMMUNITY HEALTH CENTER

Covered Entity Details

Entity Name

PORTLAND COMMUNITY HEALTH CENTER

Subdivision Name

Greater Portland Health at 180 Park Avenue

Type

HRSA-Funded Health Center

340B ID

CHC25680-00

Entity Address

180 Park Ave
Portland, ME 04102-2957

Grant Number

H80CS25680

Participating Start Date

10/1/2013

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

CVS STATE CAPITAL, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00143
384 ELM ST.
BIDDEFORD, ME 04005

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

Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/14/2021

340B Drug Pricing Program Database