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WAL-MART PHARMACY 10-3269
RRC200024-00 CENTRAL MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
CENTRAL MAINE MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC200024-00
Entity Address
300 MAIN STREET
LEWISTON, ME 04240-4500
Medicare Provider Number
200024
Participating Start Date
10/1/2017
Last Recertification Date
9/13/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3269
Pharmacy Address
258 RIVER ROAD
MEXICO, ME 04257
Pharmacy Comments
Contract Details
Approval Date
8/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Philippe Morissette, VP of Finance
(207) 795-2972
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
8/7/2017
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