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RAINA RX LLC
CHC25680-00 PORTLAND COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PORTLAND COMMUNITY HEALTH CENTER
Subdivision Name
Greater Portland Health at 180 Park Avenue
Type
HRSA-Funded Health Center
340B ID
CHC25680-00
Entity Address
180 Park Ave
Portland, ME 04102-2957
Grant Number
H80CS25680
Participating Start Date
10/1/2013
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
RAINA RX LLC
Pharmacy Address
DBA ROUTE 300 PHARMACY
1208 ROUTE 300
SUITE 103
NEWBURGH, NY 12550
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ann Tucker, Chief Executive Officer
(207) 874-2141 Ext: 3886
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
4/12/2024
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