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WALGREEN EASTERN CO., INC.
DSH200039 MAINEGENERAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200039
Entity Address
35 Medical Center Parkway
Augusta, ME 04330
Medicare Provider Number
200039
Participating Start Date
7/1/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
RITE AID #04153
83 HOSPITAL ST
AUGUSTA, ME 04330
Pharmacy Comments
Contract Details
Approval Date
2/14/2018
Contract Begin Date
2/14/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Terrance Brann, Chief Financial Officer
(207) 623-6624
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/14/2018
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