Contract Pharmacy Details

RITE AID OF MAINE, INC.
SCH200037-00 Franklin Memorial Hospital

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

6/2/2017

Contract Begin Date

7/1/2017

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
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

6/2/2017

340B Drug Pricing Program Database