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CVS STATE CAPITAL, L.L.C.
STD04101 City of Portland
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Covered Entity Details
Entity Name
City of Portland
Subdivision Name
Portland Public Health Division
Type
Sexually Transmitted Diseases
340B ID
STD04101
Entity Address
389 Congress Street
Portland, ME 04101
Grant Number
NH25PS005183
Participating Start Date
7/1/2018
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
CVS PHARMACY # 16678
200 RUNNING HILL RD
SOUTH PORTLAND, ME 04106
Pharmacy Comments
Contract Details
Approval Date
1/17/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bridget Rauscher, Clinical Health Program Manager
(207) 874-8634
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2024
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