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M DRUG LLC DBA NORTHERN LIGHT PHARMACY D
DSH200033 EASTERN MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200033
Entity Address
489 STATE STREET
BANGOR, ME 04401
Medicare Provider Number
200033
Participating Start Date
10/1/2003
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
Maura Kelly, VP Finance
(207) 593-2991
Contract Pharmacy Representative
M DRUG llc
Matthew Marston, Interim Director
(207) 275-3239
Signed By Date
1/16/2024
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