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CVS STATE CAPITAL, L.L.C.
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
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00378
770 ROOSEVELT TRAIL, RTE 302
SHAWS PLZ
WINDHAM, ME 04062
Pharmacy Comments
Contract Details
Approval Date
10/19/2021
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/19/2021
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