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RITE AID OF MAINE, INC.
DSH200050 MAINE COAST MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MAINE COAST MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200050
Entity Address
50 UNION STREET
ELLSWORTH, ME 04650
Medicare Provider Number
200050
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #3287
260 HIGH STREET
ELLSWORTH, ME 04605
Pharmacy Comments
Contract Details
Approval Date
3/5/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Contacts
Covered Entity Signing Official
Chris D. Frauenhofer, Chief Financial Officer
(207) 664-5308
Contract Pharmacy Representative
Rite Aid
Chris Hall, Senior Vice President
(717) 214-8834
Signed By Date
3/5/2015
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