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Walgreens Central Fill #21400
CHC25680-05 PORTLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PORTLAND COMMUNITY HEALTH CENTER
Subdivision Name
Greater Portland Health at Casco Bay High School
Type
HRSA-Funded Health Center
340B ID
CHC25680-05
Entity Address
196 ALLEN AVE
PORTLAND, ME 04103-3711
Grant Number
H80CS25680
Participating Start Date
1/1/2017
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21400
Pharmacy Address
44 Cabot Blvd.
Mansfield, MA 02048
Pharmacy Comments
Contract Details
Approval Date
1/15/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2023
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