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M DRUG LLC
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
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
M DRUG LLC
Pharmacy Address
DBA NORTHERN LIGHT PHARMACY
70 BENNETT ST
BANGOR, ME 04401
Pharmacy Comments
Contract Details
Approval Date
1/16/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
DEAN BITHER, VICE PRESIDENT OF FINANCE
(207) 861-3013
Contract Pharmacy Representative
Miller Drug
Vinnie Mainella, CFO
(207) 907-2341
Signed By Date
1/16/2015
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