Covered Entity Details

CAH201300-08 BLUE HILL MEMORIAL HOSPITAL (Active) - information as of 5/4/2025 10:26:39 PM

Main Details

Name

BLUE HILL MEMORIAL HOSPITAL

Subdivision Name

Blue Hill Urology

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH201300-08

Medicare Provider Number

201300

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/15/2013

Participating Start Date

7/1/2013

Participating Approval Date

4/23/2013

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

Maine Coast Hospital
Wendy June Merchant, VP of Finance
(207) 610-2429

Primary Contact

Northern Light Health
Corey Michael Taylor, Director of Pharmacy
(207) 664-5468

Addresses

Street Address

58 Main St
Bucksport, ME 04416

Billing Address

Blue Hill Memorial Hospital
57 Water Street
Blue Hill, ME 04614

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	1023057809-011	1023057809

Shipping Addresses

Shipping Address 1

Blue Hill Memorial Hospital
57 Water Street
Blue Hill, ME 04614

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
CAH201300-01	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Blue Hill Family Medicine	65 Water Street	Blue Hill	ME	Active
CAH201300-02	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Bucksport Rehabilitation and Specialty Services	58 Main Street	Bucksport	ME	Active
CAH201300-03	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Island Family Medicine	354 Airport Road	Stonington	ME	Active
CAH201300-04	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Castine Community Health	102 Court Street	Castine	ME	Active
CAH201300-05	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Blue Hill Women's Health	65 Water Street	Blue Hill	ME	Active
CAH201300-06	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Frenchman Bay Orthopedics at Blue Hill Memorial Hospital	65 Water Street	Blue Hill	ME	Active
CAH201300-07	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Blue Hill Medical Specialties	65 Water Street	Blue Hill	ME	Active
CAH201300-08	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Blue Hill Urology	58 Main St	Bucksport	ME	Active
CAH201300-09	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Blue Hill Cardiology	65 Water Street	Blue Hill	ME	Active
CAH201300-10	Child	CAH	BLUE HILL MEMORIAL HOSPITAL	Blue Hill Specialty Clinic - Infusion	65 Water Street	Blue Hill	ME	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Merchant, Wendy June VP of Finance Maine Coast Hospital 2076645633	Merchant, Wendy June VP of Finance Maine Coast Hospital 2076102429	3/21/2025 3:05 PM
Contacts	Primary Contact	Update	PC Change Request	Breece, Nathaniel Warren Director of Pharmacy Maine Coast Hospital/Blue Hill Hospital 2076645468	Taylor, Corey Michael Director of Pharmacy Northern Light Health 2076645468	3/5/2025 10:50 AM
Details	Last Recertification Date	Update	Recertification	8/30/2023 11:20:09 AM	9/9/2024 11:17:50 AM	9/9/2024 11:17 AM
Contacts	Authorizing Official	Update	AO Change Request	Jones, Wendy J VP of Finance BHMH 2073743409	Merchant, Wendy June VP of Finance Maine Coast Hospital 2076645633	9/13/2023 11:38 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 10:11:48 AM	8/30/2023 11:20:09 AM	8/30/2023 11:20 AM
Contacts	Primary Contact	Update	Change Request	Dempsey, Kevin Director of Pharmacy Blue Hill Memorial Hospital 2073743483	Breece, Nathaniel Warren Director of Pharmacy Maine Coast Hospital/Blue Hill Hospital 2076645468	3/22/2023 6:53 AM
Details	Last Recertification Date	Update	Recertification	9/2/2021 12:50:27 PM	9/7/2022 10:11:48 AM	9/7/2022 10:11 AM
Details	Last Recertification Date	Update	Recertification	8/28/2020 12:18:04 PM	9/2/2021 12:50:27 PM	9/2/2021 12:50 PM
Medicaid Billing	NPI: State	Update	Recertification		ME	8/28/2020 12:18 PM
Details	Last Recertification Date	Update	Recertification	9/11/2019 1:07:07 PM	8/28/2020 12:18:04 PM	8/28/2020 12:18 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 2:15:20 PM	9/11/2019 1:07:07 PM	9/11/2019 1:07 PM
Details	Last Recertification Date	Update	Recertification	11/30/2017 11:59:02 AM	8/22/2018 2:15:20 PM	8/22/2018 2:15 PM
Contacts	Primary Contact	Insert	Recertification		Dempsey, Kevin Director of Pharmacy Blue Hill Memorial Hospital 2073743483	11/30/2017 11:59 AM
Details	Last Recertification Date	Update	Recertification	8/31/2016 12:00:00 AM	11/30/2017 11:59:02 AM	11/30/2017 11:59 AM
Contacts	Authorizing Official	Update	AO Change Request	OLIVIER, EDWARD J. CHIEF FINANCIAL OFFICER 2073743414	Jones, Wendy J VP of Finance BHMH 2073743409	11/30/2017 9:01 AM
Contacts	Signed By	Insert			OXLEY, SCOTT INTERIM CFO 2073743414	6/30/2017 5:06 PM
Addresses	Main Address	Insert			58 Main St Bucksport, ME 04416	6/30/2017 5:06 PM
Addresses	Billing Address	Insert			Blue Hill Memorial Hospital 57 Water Street Blue Hill, ME 04614	6/30/2017 5:06 PM
Addresses	Shipping Address	Insert			Blue Hill Memorial Hospital 57 Water Street Blue Hill, ME 04614	6/30/2017 5:06 PM
Medicaid Billing	Medicaid: Number	Update		1023057809	1023057809-011	6/30/2017 5:05 PM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 2:11 PM
Details	Last Recertification Date	Update		9/9/2014 12:00:00 AM	8/17/2015 12:00:00 AM	9/9/2015 12:48 PM
Details	Last Recertification Date	Update		9/12/2013 12:00:00 AM	9/9/2014 12:00:00 AM	9/9/2014 5:18 PM
Contacts	Authorizing Official	Insert			OLIVIER, EDWARD J. CHIEF FINANCIAL OFFICER 2073743414	9/12/2013 4:58 PM
Details	Last Recertification Date	Update			9/12/2013 12:00:00 AM	9/12/2013 4:58 PM
Details	340B ID	Update		ISAPCAH201300-08	CAH201300-08	4/23/2013 11:02 AM
Dates	Participating Approval Date	Update			4/23/2013 12:00:00 AM	4/23/2013 11:02 AM
Details	State	Update		Pending	Active	4/23/2013 11:02 AM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	4/23/2013 11:02 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	ISAPCAH201300-08	4/18/2013 3:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/15/2013 1:31 PM
Medicaid Billing	Medicaid: Number	Insert			1023057809	4/15/2013 1:31 PM
Medicaid Billing	Medicaid: State	Insert			ME	4/15/2013 1:31 PM
Medicaid Billing	NPI: Number	Insert			1023057809	4/15/2013 1:31 PM
Details	Last Recertification Date	Insert				4/15/2013 1:31 PM
Details	Grant Number	Insert				4/15/2013 1:31 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/15/2013 1:31 PM
Details	Is Authorizing Official EHB Data	Insert				4/15/2013 1:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/15/2013 1:31 PM
Details	Medicare Provider Number	Insert			201300	4/15/2013 1:31 PM
Details	Entity Name	Insert			BLUE HILL MEMORIAL HOSPITAL	4/15/2013 1:31 PM
Details	Program Code	Insert			CAH	4/15/2013 1:31 PM
Details	Entity Subname	Insert			Blue Hill Urology	4/15/2013 1:31 PM
Dates	Participating Approval Date	Insert				4/15/2013 1:31 PM
Details	State	Insert			Pending	4/15/2013 1:31 PM
Dates	Registration Date	Insert			4/15/2013 12:00:00 AM	4/15/2013 1:31 PM
Dates	Signed By Date	Insert			4/15/2013 12:00:00 AM	4/15/2013 1:31 PM
Dates	Start Date	Insert				4/15/2013 1:31 PM
Terminations	Termination Comments	Insert				4/15/2013 1:31 PM
Terminations	Termination Date	Insert				4/15/2013 1:31 PM
Terminations	Termination Effective Date	Insert				4/15/2013 1:31 PM
Terminations	Termination Reason	Insert				4/15/2013 1:31 PM