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M DRUG LLC DBA MILLER DRUG STATE STREET
HV00729 Health Equity Alliance (HEAL)
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Covered Entity Details
Entity Name
Health Equity Alliance (HEAL)
Subdivision Name
Type
Ryan White Part C
340B ID
HV00729
Entity Address
5 Long Lane
Suite 1
Ellsworth, ME 04605
Grant Number
H76HA00729
Participating Start Date
4/1/2017
Last Recertification Date
2/11/2025
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
M DRUG LLC DBA MILLER DRUG STATE STREET
Pharmacy Address
210 STATE STREET
BANGOR, ME 04401
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kenney Miller, Executive Director
(207) 667-3506 Ext: 13
Contract Pharmacy Representative
Vincent A. Mainella, Chief Operating Officer
(207) 275-3239
Signed By Date
4/17/2017
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