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Walmart Pharmacy 10-7611
DSH200018 THE AROOSTOOK MEDICAL CENTER
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Covered Entity Details
Entity Name
THE AROOSTOOK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200018
Entity Address
140 ACADEMY STREET
PRESQUE ISLE, ME 04769
Medicare Provider Number
200018
Participating Start Date
7/1/2016
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
Walmart Pharmacy 10-7611
Pharmacy Address
2501 Perry Rd
Plainfield, IN 46168
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
Samuel Jacob Dobson, VP of Finance
(207) 768-4268
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/16/2024
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