Contract Pharmacy Details

WAL-MART PHARMACY 10-3269
DSH200024 CENTRAL MAINE MEDICAL CENTER

Covered Entity Details

Entity Name

CENTRAL MAINE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200024

Entity Address

300 MAIN STREET
LEWISTON, ME 04240-4500

Medicare Provider Number

200024

Participating Start Date

4/1/2022

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

WAL-MART PHARMACY 10-3269

Pharmacy Address

258 RIVER ROAD
MEXICO, ME 04257

Pharmacy Comments

Contract Details

Approval Date

1/25/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Agreement registered in error

Contacts

Covered Entity Signing Official

Steve Littleson, Interim President & CEO
(207) 795-2947

Contract Pharmacy Representative

WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498

Signed By Date

1/17/2022

340B Drug Pricing Program Database