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KENNEBEC PHARMACY & HOME CARE
DSH200039 MAINEGENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200039
Entity Address
35 Medical Center Parkway
Augusta, ME 04330
Medicare Provider Number
200039
Participating Start Date
7/1/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
KENNEBEC PHARMACY & HOME CARE
Pharmacy Address
43 LEIGHTON RD
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
2/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Terrance Brann, Chief Financial Officer
(207) 623-6624
Contract Pharmacy Representative
Kennebec Pharmacy and Home Care
Joe McVety, VP of Pharmacy
(207) 626-2726
Signed By Date
1/12/2018
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