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WALGREEN EASTERN CO., INC.
CAH201314-00 REDINGTON-FAIRVIEW GENERAL HOSPITAL
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Covered Entity Details
Entity Name
REDINGTON-FAIRVIEW GENERAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201314-00
Entity Address
46 FAIRVIEW AVE
SKOWHEGAN, ME 04976
Medicare Provider Number
201314
Participating Start Date
4/1/2011
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #11373
403 WATER ST.
AUGUSTA, ME 04330
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/24/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
ELMER DOUCETTE, CHIEF FINANCIAL OFFICER
(207) 858-2176
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2018
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