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CVS STATE CAPITAL, L.L.C.
FQHCLA119AA Community Clinical Services, Inc.
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Covered Entity Details
Entity Name
Community Clinical Services, Inc.
Subdivision Name
CCS Behavioral at Mollison
Type
Health Center Program Look-Alike
340B ID
FQHCLA119AA
Entity Address
15 Mollison Way
Room A
Lewiston, ME 04240-5805
Grant Number
LALCS00085
Participating Start Date
10/1/2016
Last Recertification Date
2/9/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02382
8 UNION STREET
AUBURN, ME 04210
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
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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