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SHAWS SUPERMARKETS INC
CAH201304-00 MOUNT DESERT ISLAND HOSPITAL
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Covered Entity Details
Entity Name
MOUNT DESERT ISLAND HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201304-00
Entity Address
10 WAYMAN LANE
BAR HARBOR, ME 04609
Medicare Provider Number
201304
Participating Start Date
9/29/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
SHAWS SUPERMARKETS INC
Pharmacy Address
SHAWS PHARMACY #0057
175 HIGH ST
ELLSWORTH, ME 04605
Pharmacy Comments
Contract Details
Approval Date
4/6/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina J. Maguire, President/CEO
(207) 288-5082 Ext: 1330
Contract Pharmacy Representative
Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304
Signed By Date
4/6/2018
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