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WAL-MART PHARMACY 10-1919
CH01458BN PENOBSCOT COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
PENOBSCOT COMMUNITY HEALTH CENTER
Subdivision Name
Old Town Elementary School RSU 34
Type
HRSA-Funded Health Center
340B ID
CH01458BN
Entity Address
576 Stillwater Ave
Old Town, ME 04468-2131
Grant Number
H80CS04291
Participating Start Date
4/1/2024
Last Recertification Date
3/6/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1919
Pharmacy Address
250 WEST BROADWAY
LINCOLN, ME 04457
Pharmacy Comments
Contract Details
Approval Date
7/20/2024
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
7/20/2024
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