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WALGREEN EASTERN CO., INC.
DSH200018 THE AROOSTOOK MEDICAL CENTER
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Covered Entity Details
Entity Name
THE AROOSTOOK MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200018
Entity Address
140 ACADEMY STREET
PRESQUE ISLE, ME 04769
Medicare Provider Number
200018
Participating Start Date
7/1/2016
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19019
355 MAIN ST
FORT FAIRFIELD, ME 04742-1143
Pharmacy Comments
Contract Details
Approval Date
2/1/2018
Contract Begin Date
2/7/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/23/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Maura Kelly, CFO
(207) 768-4737
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/1/2018
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