Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH200034 St. Mary's Regional Medical Center

Covered Entity Details

Entity Name

St. Mary's Regional Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200034

Entity Address

93 Campus Avenue
Lewiston, ME 04240-6030

Medicare Provider Number

200034

Participating Start Date

10/1/2002

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #19397
61 UNION ST
AUBURN, ME 04210

Pharmacy Comments

Contract Details

Approval Date

1/23/2018

Contract Begin Date

1/25/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/9/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Michael Hendrix, CFO/Treasurer
(207) 777-8865

Contract Pharmacy Representative

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

Signed By Date

1/23/2018

340B Drug Pricing Program Database