340B Drug Pricing Program Database
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Walmart Pharmacy 10-7611
CAH301307-00 MaineHealth Memorial Hospital
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Covered Entity Details
Entity Name
MaineHealth Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH301307-00
Entity Address
3073 White Mountain Hwy
North Conway, NH 03860-7101
Medicare Provider Number
301307
Participating Start Date
10/1/2011
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
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diana McLaughlin, CFO
(603) 356-0613
Contract Pharmacy Representative
Walmart
Van Donn, Director of Contracting 340b
(303) 261-5549
Signed By Date
1/11/2024
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