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RITE AID OF MAINE, INC.
DSH200033 EASTERN MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200033
Entity Address
489 STATE STREET
BANGOR, ME 04401
Medicare Provider Number
200033
Participating Start Date
10/1/2003
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #3296
713 BROADWAY
BANGOR, ME 04401
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2018
Ownership change
Contacts
Covered Entity Signing Official
Elmer Doucette, Vice President & CFO
(207) 973-6488
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/12/2013
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