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WALGREEN EASTERN CO., INC.
FQHCLA119AC Community Clinical Services, Inc.
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Covered Entity Details
Entity Name
Community Clinical Services, Inc.
Subdivision Name
CCS Behavioral at AMA
Type
Health Center Program Look-Alike
340B ID
FQHCLA119AC
Entity Address
2 Great Falls Plaza
Suite 21, Room A
Auburn, ME 04210-5896
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
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #19802
430 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
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/16/2023
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