Contract Pharmacy Details

WALGREENS SPECIALTY PHARMACY, LLC
RRC200024-00 CENTRAL MAINE MEDICAL CENTER

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

WALGREENS SPECIALTY PHARMACY, LLC

Pharmacy Address

DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188

Pharmacy Comments

Contract Details

Approval Date

1/8/2018

Contract Begin Date

4/1/2018

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

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/8/2018

340B Drug Pricing Program Database