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HANNAFORD BROS. CO., LLC
CH01458BL Penobscot Community Health Center
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Covered Entity Details
Entity Name
Penobscot Community Health Center
Subdivision Name
Adult Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH01458BL
Entity Address
1068 Union St
Bangor, ME 04401-3016
Grant Number
H80CS04291
Participating Start Date
4/1/2020
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
HANNAFORD BROS. CO., LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #81
500 STILLWATER AVE
OLD TOWN, ME 04468
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
Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044
Signed By Date
4/19/2024
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