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HANNAFORD BROS. CO., LLC
CH013280 D.F.D. RUSSELL MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
D.F.D. RUSSELL MEDICAL CENTER, INC.
Subdivision Name
DFD RUSSELL MEDICAL CENTER - LEEDS
Type
HRSA-Funded Health Center
340B ID
CH013280
Entity Address
180 Church Hill Rd
Leeds, ME 04263-3418
Grant Number
H80CS00642
Participating Start Date
1/1/2001
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
HANNAFORD BROS. CO., LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #81
109 PORTLAND ROAD
BRIDGTON, ME 04009
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laurie Kane-Lewis, CEO
(207) 524-4001
Contract Pharmacy Representative
Hannaford
Mike Fish, Pharmacy District Manager
(518) 428-2712
Signed By Date
1/11/2022
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