Contract Pharmacy Details

CMMC PHARMACY
CAH201310-00 BRIDGTON HOSPITAL

Covered Entity Details

Entity Name

BRIDGTON HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH201310-00

Entity Address

10 HOSPITAL DRIVE
BRIDGTON, ME 04009

Medicare Provider Number

201310

Participating Start Date

8/31/2010

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

CMMC PHARMACY

Pharmacy Address

12 HIGH ST
LEWISTON, ME 04240-7676

Pharmacy Comments

Contract Details

Approval Date

4/14/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Philippe Morissette, VP of Finance
(207) 795-2972

Contract Pharmacy Representative

Kristin Maguire, Pharmacy Manager
(207) 795-8106

Signed By Date

4/14/2014