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WALGREEN EASTERN CO., INC.
DSH200063 PENOBSCOT BAY MEDICAL CENTER
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Covered Entity Details
Entity Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200063
Entity Address
6 Glen Cove Dr
Rockport, ME 04856
Medicare Provider Number
200063
Participating Start Date
4/1/2006
Last Recertification Date
8/26/2024
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
1/16/2018
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
Linda Drinkwater, CFO
(207) 505-4104
Contract Pharmacy Representative
Walgreen
Anita Sokol, Account Manager
(718) 776-8116
Signed By Date
1/16/2018
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