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WAL-MART PHARMACY 10-2046
HV24741 MaineGeneral Medical Center
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Covered Entity Details
Entity Name
MaineGeneral Medical Center
Subdivision Name
Horizon Program
Type
Ryan White Part C
340B ID
HV24741
Entity Address
21 Enterprise Drive
Augusta, ME 04330
Grant Number
H76HA24741
Participating Start Date
1/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2046
Pharmacy Address
201 CIVIC CENTER DRIVE
AUGUSTA, ME 04330
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gillian LaPlante, Program Manager
(207) 248-0460
Contract Pharmacy Representative
Walmart
Nick Tallman, Sr. Director, Merchandise Operations – Pharmacy
(479) 371-0417
Signed By Date
10/7/2024
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