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RITE AID OF MAINE, INC.
DSH200024 CENTRAL MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
CENTRAL MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200024
Entity Address
300 MAIN STREET
LEWISTON, ME 04240-4500
Medicare Provider Number
200024
Participating Start Date
4/1/2022
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #4147
62 WEST GRAY ROAD
GRAY, ME 04039
Pharmacy Comments
Contract Details
Approval Date
2/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Contacts
Covered Entity Signing Official
Matthew Cox, CFO
(207) 795-0111
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/10/2013
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