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AVITA PHARMACY 1040
CH010380 REGIONAL MEDICAL CENTER AT LUBEC
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Covered Entity Details
Entity Name
REGIONAL MEDICAL CENTER AT LUBEC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH010380
Entity Address
43 SOUTH LUBEC ROAD
LUBEC, ME 04652
Grant Number
H80CS00150
Participating Start Date
1/1/1997
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
4/1/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom MacDonald, CEO
(207) 733-1090 Ext: 5201
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/1/2025
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