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ELIXIR PHARMACY, LLC
DSH200034 St. Mary's Regional Medical Center
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Covered Entity Details
Entity Name
St. Mary's Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200034
Entity Address
93 Campus Avenue
Lewiston, ME 04240-6030
Medicare Provider Number
200034
Participating Start Date
10/1/2002
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ELIXIR PHARMACY, LLC
Pharmacy Address
7835 FREEDOM AVE NW
NORTH CANTON, OH 44720
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Hendrix, CFO/Treasurer
(207) 777-8865
Contract Pharmacy Representative
Elixir Pharmacy LLC
Bill Trexler, Vice President Finance
(877) 437-9012
Signed By Date
1/16/2023
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