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RITE AID OF MAINE, INC.
CAH201307-00 MILLINOCKET REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MILLINOCKET REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201307-00
Entity Address
200 SOMERSET STREET
MILLINOCKET, ME 04462
Medicare Provider Number
201307
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #4273
720 CENTRAL STREET
MILLINOCKET, ME 04462
Pharmacy Comments
Contract Details
Approval Date
7/12/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2018
Ownership change
Contacts
Covered Entity Signing Official
MARIE VIENNEAU, CEO
(207) 723-5161 Ext: 319
Contract Pharmacy Representative
Rite Aid
Chris Hall, Senior Vice President
(717) 214-8834
Signed By Date
7/12/2013
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