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WAL-MART PHARMACY 10-5076
CH01458BM Penobscot Community Health Center
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Covered Entity Details
Entity Name
Penobscot Community Health Center
Subdivision Name
Bangor School Department School-Based Health Center
Type
HRSA-Funded Health Center
340B ID
CH01458BM
Entity Address
885 Broadway
Bangor, ME 04401-2916
Grant Number
H80CS04291
Participating Start Date
7/1/2022
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5076
Pharmacy Address
24 WALTON DR
BREWER, ME 04412
Pharmacy Comments
Contract Details
Approval Date
7/19/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lorelle Dwyer, President & CEO
(207) 992-9200
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/19/2024
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