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WALGREEN EASTERN CO., INC.
DSH200033 EASTERN MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200033
Entity Address
489 STATE STREET
BANGOR, ME 04401
Medicare Provider Number
200033
Participating Start Date
10/1/2003
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
RITE AID #03279
422 WILSON ST
BREWER, ME 04412
Pharmacy Comments
Contract Details
Approval Date
1/31/2018
Contract Begin Date
2/7/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/4/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Helen McKinnon, VP Support Services
(207) 973-7842
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/31/2018
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