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WALGREEN EASTERN CO., 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
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #11742
226 HIGH STREET
ELLSWORTH, ME 04605-1742
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2015
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