Contract Pharmacy Details

RITE AID OF MAINE, INC.
DSH200039 MAINEGENERAL MEDICAL CENTER

Covered Entity Details

Entity Name

MAINEGENERAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200039

Entity Address

35 Medical Center Parkway
Augusta, ME 04330

Medicare Provider Number

200039

Participating Start Date

7/1/2008

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

RITE AID OF MAINE, INC.

Pharmacy Address

RITE AID #4167
210 MAIN STREET
WATERVILLE, ME 04901

Pharmacy Comments

Contract Details

Approval Date

2/15/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/18/2018
Ownership change

Contacts

Covered Entity Signing Official

MICHAEL KOZIOL, SR VP/CHIEF FINANCIAL OFFICER
(207) 626-1212

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

1/10/2013

340B Drug Pricing Program Database