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WALGREEN EASTERN CO., INC.
DSH200041 INLAND HOSPITAL
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Covered Entity Details
Entity Name
INLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200041
Entity Address
200 KENNEDY MEMORIAL DRIVE
WATERVILLE, ME 04901
Medicare Provider Number
200041
Participating Start Date
7/1/2008
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19674
36 CHINA RD
WINSLOW, ME 04901
Pharmacy Comments
Contract Details
Approval Date
1/19/2018
Contract Begin Date
2/7/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chris Frauenhofer, VICE PRESIDENT OF FINANCE
(207) 861-3013
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/19/2018
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