Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH200041 INLAND HOSPITAL

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

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #11373
403 WATER ST.
AUGUSTA, ME 04330

Pharmacy Comments

Contract Details

Approval Date

7/14/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DEAN BITHER, VICE PRESIDENT OF FINANCE
(207) 861-3013

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/14/2014

340B Drug Pricing Program Database