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CVS STATE CAPITAL, L.L.C.
CAH201316-00 MaineHealth Franklin Hospital
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Covered Entity Details
Entity Name
MaineHealth Franklin Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201316-00
Entity Address
111 Franklin Health Commons
Farmington, ME 04938
Medicare Provider Number
201316
Participating Start Date
8/20/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
CVS STATE CAPITAL, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04158
24 STONE ST., STE120
AUGUSTA, ME 04330
Pharmacy Comments
Contract Details
Approval Date
8/20/2024
Contract Begin Date
8/20/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Bazemore, Chief Financial Officer
(207) 779-2114
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/19/2024
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