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WAL-MART PHARMACY 10-1932
CAH201304-00 MOUNT DESERT ISLAND HOSPITAL
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Covered Entity Details
Entity Name
MOUNT DESERT ISLAND HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201304-00
Entity Address
10 WAYMAN LANE
BAR HARBOR, ME 04609
Medicare Provider Number
201304
Participating Start Date
9/29/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1932
Pharmacy Address
17 MYRICK STREET
ELLSWORTH, ME 04605
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
Christina J. Maguire, President/CEO
(207) 288-5082 Ext: 1330
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/14/2014
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