Contract Pharmacy Details

MAINEHEALTH
SCH200037-00 Franklin Memorial Hospital

Covered Entity Details

Entity Name

Franklin Memorial Hospital

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH200037-00

Entity Address

111 Franklin Health Commons
Farmington, ME 04938

Medicare Provider Number

200037

Participating Start Date

7/1/2017

Last Recertification Date

9/5/2023

Entity Termination Date

8/20/2024

Pharmacy Details

Pharmacy Name

MAINEHEALTH

Pharmacy Address

MAINEHEALTH PHARMACY SPECIALTY AND HOME
340 COUNTY RD
WESTBROOK, ME 04092

Pharmacy Comments

Contract Details

Approval Date

7/15/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/20/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

albert swallow, cfo
(207) 661-7529

Contract Pharmacy Representative

MaineHealth
Andrea Lai, Senior Director of Ambulatory Pharmacy
(207) 662-5366

Signed By Date

7/15/2022

340B Drug Pricing Program Database