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Walmart Pharmacy 10-7611
CAH201315-00 MAINEHEALTH STEPHENS HOSPITAL
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Covered Entity Details
Entity Name
MAINEHEALTH STEPHENS HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201315-00
Entity Address
181 Main Street
Norway, ME 04268
Medicare Provider Number
201315
Participating Start Date
1/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Debbie A Gould, CFO
(207) 744-6006
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting
(479) 277-3719
Signed By Date
1/11/2024
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