340B Drug Pricing Program Database

Pharmacy Name

CVS STATE CAPITAL, L.L.C.

Pharmacy Address

CVS PHARMACY # 16975
60 LONGVIEW DR
BANGOR, ME 04401

Pharmacy Comments

Approval Date

4/13/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Helen McKinnon, VP Support Services
(207) 973-7842

Contract Pharmacy Representative

CVS Health
Jaclyn Parfitt, 340B Operations Manager
(401) 770-6467

Signed By Date

4/13/2017