340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH201302-00 Lincoln Hospital
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Covered Entity Details
Entity Name
Lincoln Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201302-00
Entity Address
35 Miles Street
Damariscotta, ME 04543-4047
Medicare Provider Number
201302
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/3/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/11/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wayne R Printy, CFO
(207) 563-4476
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
1/3/2024
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