Contract Pharmacy Details

RITE AID OF MAINE, INC.
CAH201312-00 MAINEHEALTH WALDO HOSPITAL

Covered Entity Details

Entity Name

MAINEHEALTH WALDO HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH201312-00

Entity Address

118 NORTHPORT AVENUE
BELFAST, ME 04915

Medicare Provider Number

201312

Participating Start Date

9/9/2010

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

RITE AID OF MAINE, INC.

Pharmacy Address

RITE AID #4149
254 MAIN STREET
BELFAST, ME 04915

Pharmacy Comments

Contract Details

Approval Date

4/1/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/18/2018
Ownership change

Contacts

Covered Entity Signing Official

LINDA DRINKWATER, CHIEF FINANCIAL OFFICER
(207) 338-2500 Ext: 4104

Contract Pharmacy Representative

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

Signed By Date

4/1/2013

340B Drug Pricing Program Database