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CVS STATE CAPITAL, L.L.C.
CH01458W PENOBSCOT COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
Subdivision Name
PENOBSCOT PEDIATRICS
Type
HRSA-Funded Health Center
340B ID
CH01458W
Entity Address
6 Telcom Drive
BANGOR, ME 04401
Grant Number
H80CS04291
Participating Start Date
1/1/2007
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
CVS PHARMACY # 16975
60 LONGVIEW DR
BANGOR, ME 04401
Pharmacy Comments
Contract Details
Approval Date
4/19/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lorelle Dwyer, President & CEO
(207) 992-9200
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/19/2024
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