Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
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

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #11373
403 WATER ST.
AUGUSTA, ME 04330

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

3/24/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/17/2022

340B Drug Pricing Program Database