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WALGREEN EASTERN CO., INC.
DSH200052 NORTHERN MAINE MEDICAL CENTER
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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
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #18248
112 BENNETT DR
CARIBOU, ME 04736
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/13/2023
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