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RITE AID OF MAINE, INC.
DSH200037 FRANKLIN MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
FRANKLIN MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200037
Entity Address
111 FRANKLIN HEALTH COMMONS
FARMINGTON, ME 04938
Medicare Provider Number
200037
Participating Start Date
10/1/2016
Last Recertification Date
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #3292
81 MAIN STREET
LIVERMORE FALLS, ME 04254
Pharmacy Comments
Contract Details
Approval Date
9/30/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
Gerald R. Cayer, Vice President of Physician and Community Services
(207) 779-2265
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
9/30/2016
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