Covered Entity Details

CAH201316-04 MaineHealth Franklin Hospital (Active) - information as of 5/3/2025 11:29:14 PM

Main Details

Name

MaineHealth Franklin Hospital

Subdivision Name

Franklin Health Internal Medicine - Primary Care

Type

Critical Access Hospital

Rural

340B ID

CAH201316-04

Medicare Provider Number

201316

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/19/2024

Participating Start Date

8/20/2024

Participating Approval Date

8/20/2024

Last Recertification Date

Contacts

Authorizing Official

Franklin Community Health Network
Daniel Bazemore, Chief Financial Officer
(207) 779-2114

Primary Contact

MaineHealth
BRIAN MARDEN, Chief Pharmacy Officer
(207) 661-3057

Addresses

Street Address

181 Franklin Health Commons
Farmington, ME 04938

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
ME		1922791417,1861184509

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH201316-01	Child	CAH	MaineHealth Franklin Hospital	Franklin Primary Care - FH Primary Care - Primary Care	131 Franklin Health Commons	Farmington	ME	Active
CAH201316-02	Child	CAH	MaineHealth Franklin Hospital	Franklin Health Orthopaedics - Orthopedic Clinic	181 Franklin Health Commons	Farmington	ME	Active
CAH201316-03	Child	CAH	MaineHealth Franklin Hospital	Franklin Health Farmington Family Practice - Primary Care	181 Franklin Health Commons	Farmington	ME	Active
CAH201316-04	Child	CAH	MaineHealth Franklin Hospital	Franklin Health Internal Medicine - Primary Care	181 Franklin Health Commons	Farmington	ME	Active
CAH201316-05	Child	CAH	MaineHealth Franklin Hospital	Franklin Health Behavioral Services - Behavioral Health	181 Franklin Health Commons	Farmington	ME	Active
CAH201316-06	Child	CAH	MaineHealth Franklin Hospital	Franklin Health Womens Care - Womens Health	181 Franklin Health Commons	Farmington	ME	Active
CAH201316-07	Child	CAH	MaineHealth Franklin Hospital	Franklin Health Surgery - Surgery Clinic	181 Franklin Health Commons	Farmington	ME	Active
CAH201316-08	Child	CAH	MaineHealth Franklin Hospital	Franklin Health Pediatrics - Pediatrics	181 Franklin Health Commons	Farmington	ME	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Entity Name	Update	Change Request	Franklin Memorial Hospital	MaineHealth Franklin Hospital	3/19/2025 10:48 AM
Contacts	Primary Contact	Update	Group Change Request	Tran, Roya Director of 340B Program & Drug Supply Management Maine Health 2076610304	MARDEN, BRIAN Chief Pharmacy Officer MaineHealth 2076613057	1/10/2025 9:55 AM
Contacts	Primary Contact	Update	Group Change Request	MARDEN, BRIAN Chief Pharmacy Officer MaineHealth 2076613057	Tran, Roya Director of 340B Program & Drug Supply Management Maine Health 2076610304	8/22/2024 9:10 AM
Details	State	Update	OPA Edit	Approved	Active	8/20/2024 2:06 PM
Dates	Start Date	Update	OPA Edit	10/1/2024 12:00:00 AM	8/20/2024 12:00:00 AM	8/20/2024 2:06 PM
Contacts	Signed By	Insert	New Registration		Bazemore, Daniel Chief Financial Officer Franklin Community Health Network 2077792114	8/20/2024 2:02 PM
Details	340B ID	Update	New Registration		CAH201316-04	8/20/2024 2:02 PM
Details	Entity Subname	Update	New Registration	Franklin Health Internal Medicine	Franklin Health Internal Medicine - Primary Care	8/20/2024 2:02 PM
Dates	Participating Approval Date	Update	New Registration		8/20/2024 2:02:05 PM	8/20/2024 2:02 PM
Details	State	Update	New Registration	Pending	Approved	8/20/2024 2:02 PM
Dates	Signed By Date	Update	New Registration		7/19/2024 1:35:47 PM	8/20/2024 2:02 PM
Dates	Start Date	Update	New Registration		10/1/2024 12:00:00 AM	8/20/2024 2:02 PM
Addresses	Main Address	Insert	New Registration		181 Franklin Health Commons Farmington, ME 04938	7/19/2024 1:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1922791417	7/19/2024 1:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		ME	7/19/2024 1:21 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1861184509	7/19/2024 1:21 PM
Medicaid Billing	NPI: State	Insert	New Registration		ME	7/19/2024 1:21 PM
Contacts	Primary Contact	Insert	New Registration		MARDEN, BRIAN Chief Pharmacy Officer MaineHealth 2076613057	7/19/2024 1:21 PM
Contacts	Authorizing Official	Insert	New Registration		Bazemore, Daniel Chief Financial Officer Franklin Community Health Network 2077792114	7/19/2024 1:21 PM
Details	Assistance Received From Date	Insert	New Registration			7/19/2024 1:21 PM
Details	Assistance Received To Date	Insert	New Registration			7/19/2024 1:21 PM
Details	Last Recertification Date	Insert	New Registration			7/19/2024 1:21 PM
Details	Grant Number	Insert	New Registration			7/19/2024 1:21 PM
Details	340B ID	Insert	New Registration			7/19/2024 1:21 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/19/2024 1:21 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/19/2024 1:21 PM
Details	Medicare Provider Number	Insert	New Registration		201316	7/19/2024 1:21 PM
Details	Entity Name	Insert	New Registration		Franklin Memorial Hospital	7/19/2024 1:21 PM
Details	NOFO Number	Insert	New Registration			7/19/2024 1:21 PM
Details	Program Code	Insert	New Registration		CAH	7/19/2024 1:21 PM
Details	Entity Subname	Insert	New Registration		Franklin Health Internal Medicine	7/19/2024 1:21 PM
Dates	Participating Approval Date	Insert	New Registration			7/19/2024 1:21 PM
Details	State	Insert	New Registration		Pending	7/19/2024 1:21 PM
Dates	Registration Date	Insert	New Registration		7/19/2024 1:21:01 PM	7/19/2024 1:21 PM
Dates	Signed By Date	Insert	New Registration			7/19/2024 1:21 PM
Dates	Start Date	Insert	New Registration			7/19/2024 1:21 PM
Terminations	Termination Comments	Insert	New Registration			7/19/2024 1:21 PM
Terminations	Termination Date	Insert	New Registration			7/19/2024 1:21 PM
Terminations	Termination Effective Date	Insert	New Registration			7/19/2024 1:21 PM
Terminations	Termination Reason	Insert	New Registration			7/19/2024 1:21 PM