Contract Pharmacy Details

CVS STATE CAPITAL, L.L.C.
CAH201312-00 MAINEHEALTH WALDO HOSPITAL

Covered Entity Details

Entity Name

MAINEHEALTH WALDO HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH201312-00

Entity Address

118 NORTHPORT AVENUE
BELFAST, ME 04915

Medicare Provider Number

201312

Participating Start Date

9/9/2010

Last Recertification Date

8/26/2024

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

10/5/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Heather Shanklin, Chief Financial Officer
(207) 505-4131

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/5/2022

340B Drug Pricing Program Database