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WALMART PHARMACY 10-5169
SCH200050-00 MAINE COAST MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MAINE COAST MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH200050-00
Entity Address
50 UNION STREET
ELLSWORTH, ME 04605
Medicare Provider Number
200050
Participating Start Date
4/1/2020
Last Recertification Date
9/9/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Wendy J Jones, VP of Finance
(207) 374-3409
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/17/2023
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