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CVS STATE CAPITAL, L.L.C.
CAH201302-00 Lincoln Hospital
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Covered Entity Details
Entity Name
Lincoln Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201302-00
Entity Address
35 Miles Street
Damariscotta, ME 04543-4047
Medicare Provider Number
201302
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00801
131 COURT STREET
BATH, ME 04530
Pharmacy Comments
Contract Details
Approval Date
10/16/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wayne R Printy, CFO
(207) 563-4476
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2021
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