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RITE AID OF MAINE, INC.
DSH200041 INLAND HOSPITAL
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Covered Entity Details
Entity Name
INLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200041
Entity Address
200 KENNEDY MEMORIAL DRIVE
WATERVILLE, ME 04901
Medicare Provider Number
200041
Participating Start Date
7/1/2008
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #4142
506 SOMERSET AVENUE
PITTSFIELD, ME 04967
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/6/2018
Ownership change
Contacts
Covered Entity Signing Official
DEAN BITHER, VICE PRESIDENT OF FINANCE
(207) 861-3013
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/15/2013
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