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WALGREEN EASTERN CO., INC.
CAH201301-00 CHARLES A. DEAN MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHARLES A. DEAN MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201301-00
Entity Address
364 PRITHAM AVENUE
GREENVILLE, ME 04441
Medicare Provider Number
201301
Participating Start Date
1/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #17989
151 E MAIN ST
DOVER FOXCROFT, ME 04426
Pharmacy Comments
Contract Details
Approval Date
2/7/2018
Contract Begin Date
2/7/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JENNIFER GOODRICH, CFO
(207) 695-5209
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/7/2018
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