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M DRUG LLC
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
M DRUG LLC
Pharmacy Address
DBA NORTHERN LIGHT PHARMACY
70 BENNETT ST
BANGOR, ME 04401
Pharmacy Comments
Contract Details
Approval Date
5/18/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Maura Kelly, CFO
(207) 768-4737
Contract Pharmacy Representative
Miller Drug
Vinnie Mainella, CFO
(207) 907-2341
Signed By Date
5/18/2016
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