Contract Pharmacy Details

RITE AID OF MAINE, INC.
CAH201315-00 MAINEHEALTH STEPHENS HOSPITAL

Covered Entity Details

Entity Name

MAINEHEALTH STEPHENS HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH201315-00

Entity Address

181 Main Street
Norway, ME 04268

Medicare Provider Number

201315

Participating Start Date

1/1/2012

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

RITE AID OF MAINE, INC.

Pharmacy Address

RITE AID #4944
28 MAYVILLE ROAD
PO BOX 190
BETHEL, ME 04217

Pharmacy Comments

Contract Details

Approval Date

10/14/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/18/2018
Ownership change

Contacts

Covered Entity Signing Official

John W. Cox, Regional Chief Financial Officer
(207) 744-6024

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

10/14/2014

340B Drug Pricing Program Database