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M DRUG LLC DBA NORTHERN LIGHT PHARMACY D
CAH201300-00 BLUE HILL MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BLUE HILL MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201300-00
Entity Address
57 WATER STREET
BLUE HILL, ME 04614
Medicare Provider Number
201300
Participating Start Date
1/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
M DRUG LLC DBA NORTHERN LIGHT PHARMACY D
Pharmacy Address
161 HIGH ST
ELLSWORTH, ME 04605
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wendy June Merchant, VP of Finance
(207) 610-2429
Contract Pharmacy Representative
M DRUG llc
Matthew Marston, Interim Director
(207) 275-3239
Signed By Date
1/16/2024
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