340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OPTUM PHARMACY 702, LLC
CAH201317-00 NORTHERN MAINE MEDICAL CENTER
Print
Covered Entity Details
Entity Name
NORTHERN MAINE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201317-00
Entity Address
194 EAST MAIN STREET
FORT KENT, ME 04743
Medicare Provider Number
201317
Participating Start Date
12/6/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 702, LLC
Pharmacy Address
1050 PATROL RD
JEFFERSONVILLE, IN 47130
Pharmacy Comments
Contract Details
Approval Date
1/3/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alain Bois, Chief Operating Officer
(207) 834-1411
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/3/2025
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session