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HANNAFORD BROS. CO., LLC
CH01458BK PENOBSCOT COMMUNITY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC
Subdivision Name
Downeast School - PCHC Dental
Type
HRSA-Funded Health Center
340B ID
CH01458BK
Entity Address
100 Moosehead Blvd
Bangor, ME 04401-2367
Grant Number
H80CS04291
Participating Start Date
4/1/2017
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
HANNAFORD BROS. CO., LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #81
383 WILSON ST
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
Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044
Signed By Date
7/19/2024
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