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WAL-MART PHARMACY 10-2178
CHC00630-00 EASTPORT HEALTH CARE INC
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Covered Entity Details
Entity Name
EASTPORT HEALTH CARE INC
Subdivision Name
EASTPORT HEALTH CARE, INC.
Type
HRSA-Funded Health Center
340B ID
CHC00630-00
Entity Address
30 Boynton St
Eastport, ME 04631-1306
Grant Number
H80CS00630
Participating Start Date
7/1/2015
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2178
Pharmacy Address
379 SOUTH STREET
CALAIS, ME 04619
Pharmacy Comments
Contract Details
Approval Date
5/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Holly Gartmayer-DeYoung, CEO
(207) 853-4045
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
5/14/2015
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