340B Drug Pricing Program Database
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WALGREEN EASTERN CO., INC
DSH200001 ST JOSEPH HOSPITAL
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Covered Entity Details
Entity Name
ST JOSEPH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200001
Entity Address
360 BROADWAY
BANGOR, ME 04401
Medicare Provider Number
200001
Participating Start Date
1/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC
Pharmacy Address
WALGREENS #17355
66 MOOSEHEAD TRL
NEWPORT, ME 04953
Pharmacy Comments
Contract Details
Approval Date
4/10/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Allan Hendrix, Vice of President of Finance
(207) 907-1600
Contract Pharmacy Representative
Walgreens
Ruthann Archer, Director of 340B Operations
(847) 964-8116
Signed By Date
4/10/2025
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