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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
CHC25680-16 PORTLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PORTLAND COMMUNITY HEALTH CENTER
Subdivision Name
Greater Portland Health at South Portland High School
Type
HRSA-Funded Health Center
340B ID
CHC25680-16
Entity Address
637 Highland Ave
South Portland, ME 04106-6425
Grant Number
H80CS25680
Participating Start Date
4/1/2023
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2023
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