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CVS STATE CAPITAL, L.L.C.
DSH200033 EASTERN MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200033
Entity Address
489 STATE STREET
BANGOR, ME 04401
Medicare Provider Number
200033
Participating Start Date
10/1/2003
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00620
1 KENNEDY MEMORIAL DR.
WATERVILLE, ME 04901
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Philippe Morissette, SVP of Finance
(207) 973-6488
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2022
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