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MT BLUE DRUG INC
CH01046I HEALTHREACH COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
HEALTHREACH COMMUNITY HEALTH CENTERS
Subdivision Name
WESTERN MAINE FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH01046I
Entity Address
16 Depot Street
Ste 300
Livermore Falls, ME 04254-1311
Grant Number
H80CS00797
Participating Start Date
10/1/2001
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
MT BLUE DRUG INC
Pharmacy Address
624 WILTON RD
FARMINGTON, ME 04938
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CONSTANCE COGGINS, CEO
(207) 872-5610
Contract Pharmacy Representative
Holland Drug Inc
Kevin Holland, Owner
(207) 778-6015
Signed By Date
4/10/2024
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