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CVS STATE CAPITAL, L.L.C.
DSH200024 CENTRAL MAINE MEDICAL CENTER
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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
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00806
51 MARKET STREET
MILL CREEK S/C
SOUTH PORTLAND, ME 04106
Pharmacy Comments
Contract Details
Approval Date
1/25/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Littleson, Interim President & CEO
(207) 795-2947
Contract Pharmacy Representative
Central Maine Medical Center
Justin Mirick, Pharmacy Tech
(207) 795-2325
Signed By Date
1/17/2022
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