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BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
DSH200063 PENOBSCOT BAY MEDICAL CENTER
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Covered Entity Details
Entity Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200063
Entity Address
6 Glen Cove Dr
Rockport, ME 04856
Medicare Provider Number
200063
Participating Start Date
4/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
Pharmacy Address
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
145 S 79TH ST STE 70
CHANDLER, AZ 85226
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Heather Shanklin, Chief Financial Officer
(207) 505-4131
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
7/3/2024
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