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BEDARD PHARMACY INC
DSH200034 St. Mary's Regional Medical Center
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Covered Entity Details
Entity Name
St. Mary's Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200034
Entity Address
93 Campus Avenue
Lewiston, ME 04240-6030
Medicare Provider Number
200034
Participating Start Date
10/1/2002
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
BEDARD PHARMACY INC
Pharmacy Address
61 COLLEGE ST
LEWISTON, ME 04240-6805
Pharmacy Comments
Contract Details
Approval Date
7/1/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/23/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
CAROLYN KASABIAN, CFO
(207) 777-8546
Contract Pharmacy Representative
Michael Nadeau, President
(207) 786-0138
Signed By Date
7/1/2014
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