340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ST JOHN VALLEY PHARMACY LLC
DSH200052 NORTHERN MAINE MEDICAL CENTER
Print
Covered Entity Details
Entity Name
NORTHERN MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200052
Entity Address
194 EAST MAIN STREET
FORT KENT, ME 04743
Medicare Provider Number
200052
Participating Start Date
4/1/2023
Last Recertification Date
8/27/2024
Entity Termination Date
12/6/2024
Pharmacy Details
Pharmacy Name
ST JOHN VALLEY PHARMACY LLC
Pharmacy Address
182 MARKET ST
PO BOX 189
FORT KENT, ME 04743
Pharmacy Comments
Contract Details
Approval Date
1/18/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/6/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Alain Bois, Chief Operating Officer
(207) 834-1411
Contract Pharmacy Representative
Bangor Drug LTC
Charles Ouellette, Owner
(207) 834-2880
Signed By Date
1/13/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session