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WALGREEN EASTERN CO., INC.
CAH201312-00 MAINEHEALTH WALDO HOSPITAL
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Covered Entity Details
Entity Name
MAINEHEALTH WALDO HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201312-00
Entity Address
118 NORTHPORT AVENUE
BELFAST, ME 04915
Medicare Provider Number
201312
Participating Start Date
9/9/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
RITE AID #04149
254 MAIN ST
BELFAST, ME 04915
Pharmacy Comments
Contract Details
Approval Date
1/23/2018
Contract Begin Date
1/26/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/5/2018
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
1/23/2018
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