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MADAWASKA PHARMACY, L.L.C.
SCH200052-00 NORTHERN MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTHERN MAINE MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH200052-00
Entity Address
194 EAST MAIN ST
FORT KENT, ME 04743
Medicare Provider Number
200052
Participating Start Date
10/1/2014
Last Recertification Date
9/14/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
MADAWASKA PHARMACY, L.L.C.
Pharmacy Address
104 MAIN ST
MADAWASKA, ME 04756-0475
Pharmacy Comments
Contract Details
Approval Date
9/24/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/11/2018
Ownership change
Contacts
Covered Entity Signing Official
CINDY DAIGLE, CFO
(207) 834-1820 Ext: 0
Contract Pharmacy Representative
Paul Dubois, Owner/R.Ph
(207) 728-7200
Signed By Date
9/24/2014
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