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RITE AID OF MAINE, INC.
SCH200037-00 Franklin Memorial Hospital
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Covered Entity Details
Entity Name
Franklin Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH200037-00
Entity Address
111 Franklin Health Commons
Farmington, ME 04938
Medicare Provider Number
200037
Participating Start Date
7/1/2017
Last Recertification Date
9/5/2023
Entity Termination Date
8/20/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #4123
317 MAIN STREET
FARMINGTON, ME 04938
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Gerald R. Cayer, Vice President of Physician and Community Services
(207) 779-2265
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/14/2014
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