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Walgreens Central Fill #21400
CAH201303-00 PENOBSCOT VALLEY HOSPITAL
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Covered Entity Details
Entity Name
PENOBSCOT VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201303-00
Entity Address
7 TRANSALPINE ROAD
LINCOLN, ME 04457
Medicare Provider Number
201303
Participating Start Date
4/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21400
Pharmacy Address
44 Cabot Blvd.
Mansfield, MA 02048
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amy Theriault, Chief Operating Officer
(207) 794-3321
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2023
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