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Walmart Pharmacy 10-7611
CH010380 REGIONAL MEDICAL CENTER AT LUBEC
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Covered Entity Details
Entity Name
REGIONAL MEDICAL CENTER AT LUBEC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH010380
Entity Address
43 SOUTH LUBEC ROAD
LUBEC, ME 04652
Grant Number
H80CS00150
Participating Start Date
1/1/1997
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
10/6/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom MacDonald, CEO
(207) 733-1090 Ext: 5201
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/6/2023
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