340B Drug Pricing Program Database

Pharmacy Name

CVS STATE CAPITAL, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00804
1364 CONGRESS ST
PORTLAND, ME 04102-2103

Pharmacy Comments

Approval Date

7/31/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Lugene Anthony Inzana, CFO
(207) 662-2654

Contract Pharmacy Representative

Jeffrey Mattiucci, Director, Payer Relations
(401) 770-2727

Signed By Date

7/31/2014