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MAXI DRUG NORTH, INC.
CH01458W PENOBSCOT COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
Subdivision Name
PENOBSCOT PEDIATRICS
Type
HRSA-Funded Health Center
340B ID
CH01458W
Entity Address
6 Telcom Drive
BANGOR, ME 04401
Grant Number
H80CS04291
Participating Start Date
1/1/2007
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
MAXI DRUG NORTH, INC.
Pharmacy Address
RITE AID #10305
566 UNION STREET
BANGOR, ME 04401
Pharmacy Comments
Contract Details
Approval Date
2/28/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/9/2018
Ownership change
Contacts
Covered Entity Signing Official
Ken Schmidt, CEO
(207) 945-5247 Ext: 401
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/15/2013
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