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M DRUG LLC
CAH201313-00 Sebasticook Valley Health
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Covered Entity Details
Entity Name
Sebasticook Valley Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201313-00
Entity Address
447 NORTH MAIN STREET
PITTSFIELD, ME 04967
Medicare Provider Number
201313
Participating Start Date
7/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
M DRUG LLC
Pharmacy Address
DBA NORTHERN LIGHT PHARMACY
70 BENNETT ST
BANGOR, ME 04401
Pharmacy Comments
Contract Details
Approval Date
1/23/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RANDALL CLARK, PRESIDENT
(207) 487-4022
Contract Pharmacy Representative
Miller Drug
Vinnie Mainella, CFO
(207) 907-2341
Signed By Date
1/23/2015
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