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RITE AID OF MAINE, INC.
DSH200018 THE AROOSTOOK MEDICAL CENTER
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Covered Entity Details
Entity Name
THE AROOSTOOK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200018
Entity Address
140 ACADEMY STREET
PRESQUE ISLE, ME 04769
Medicare Provider Number
200018
Participating Start Date
7/1/2016
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MAINE, INC.
Pharmacy Address
RITE AID #3894
355 MAIN STREET
FORT FAIRFIELD, ME 04742
Pharmacy Comments
Contract Details
Approval Date
5/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/25/2018
Ownership change
Contacts
Covered Entity Signing Official
Maura Kelly, CFO
(207) 768-4737
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
5/18/2016
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