Contract Pharmacy Details

MAINEHEALTH
HM04101 MAINE MEDICAL CENTER

Covered Entity Details

Entity Name

MAINE MEDICAL CENTER

Subdivision Name

MAINE HEMOPHILIA AND THROMBOSIS CENTER

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM04101

Entity Address

22 BRAMHALL ST
PORTLAND, ME 04101

Grant Number

H30MC24048

Participating Start Date

4/1/2008

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

MAINEHEALTH

Pharmacy Address

MAINEHEALTH PHARMACY MAINE MEDICAL CENTE
22 BRAMHALL ST
PORTLAND, ME 04102

Pharmacy Comments

Contract Details

Approval Date

1/29/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lugene Anthony Inzana, CFO
(207) 662-2654

Contract Pharmacy Representative

Maine Medical Center
Andrea Lai, Director of Ambulatory Care Pharmacy Services
(207) 662-5366

Signed By Date

1/29/2022

340B Drug Pricing Program Database