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CVS STATE CAPITAL, L.L.C.
FQHCLA119A Community Clinical Services, Inc.
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Covered Entity Details
Entity Name
Community Clinical Services, Inc.
Subdivision Name
CCS Family Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA119A
Entity Address
100 Campus Avenue
Lewiston, ME 04240-6040
Grant Number
LALCS00085
Participating Start Date
4/1/2001
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00273
446 SABATTUS ST.
LEWISTON, ME 04240
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Coleen Lynn Elias, CEO/CFO
(207) 513-3897
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2023
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