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RED CHIP OF NEVADA
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
RED CHIP OF NEVADA
Pharmacy Address
18009 SKY PARK CIRCLE SUITE F
IRVINE, CA 92614-9261
Pharmacy Comments
Contract Details
Approval Date
1/5/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles Alsdurf, Vice President of Finance
(207) 662-3998
Contract Pharmacy Representative
Red Chip Of Nevada
Vishal Gandhi, Pharmacy Manager
(949) 223-9830
Signed By Date
1/5/2015
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