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WAL-MART PHARMACY 10-2046
SCH200037-00 Franklin Memorial Hospital
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Covered Entity Details
Entity Name
Franklin Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH200037-00
Entity Address
111 Franklin Health Commons
Farmington, ME 04938
Medicare Provider Number
200037
Participating Start Date
7/1/2017
Last Recertification Date
9/5/2023
Entity Termination Date
8/20/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2046
Pharmacy Address
201 CIVIC CENTER DRIVE
AUGUSTA, ME 04330
Pharmacy Comments
Contract Details
Approval Date
10/19/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/20/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
albert swallow, cfo
(207) 661-7529
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/19/2021
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