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STONE SOUP ENTERPRISES, INC.
HM04101 MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
MAINE MEDICAL CENTER
Subdivision Name
MAINE HEMOPHILIA AND THROMBOSIS CENTER
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM04101
Entity Address
22 BRAMHALL ST
PORTLAND, ME 04101
Grant Number
H30MC24048
Participating Start Date
4/1/2008
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
STONE SOUP ENTERPRISES, INC.
Pharmacy Address
18009 SKYPARK CIRCLE, STE G
IRVINE, CA 92614
Pharmacy Comments
Contract Details
Approval Date
11/15/2009
Contract Begin Date
11/15/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/2/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
MICHAEL TRONT, PRESIDENT
(949) 476-6361
Signed By Date
11/2/2009
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