Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
FQHCLA119AD Community Clinical Services, Inc.

Covered Entity Details

Entity Name

Community Clinical Services, Inc.

Subdivision Name

CCS Behavioral at SMMA

Type

Health Center Program Look-Alike

340B ID

FQHCLA119AD

Entity Address

99 Campus Avenue
Suite 201
Lewiston, ME 04240-6045

Grant Number

LALCS00085

Participating Start Date

1/1/2017

Last Recertification Date

2/9/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #17136
315 MAIN STREET
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

2/27/2024
Pharmacy closed

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

340B Drug Pricing Program Database