Covered Entity Details

DSH200024AB CENTRAL MAINE MEDICAL CENTER (Terminated) - information as of 6/27/2025 5:44:14 AM

Main Details

Name

CENTRAL MAINE MEDICAL CENTER

Subdivision Name

Brunswick Family Medicine

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH200024AB

Medicare Provider Number

200024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/10/2014

Participating Start Date

4/1/2014

Participating Approval Date

2/27/2014

Last Recertification Date

8/6/2015

Termination Date
Termination Reason

1/1/2016
DSH percentage below statutory minimum

Contacts

Authorizing Official

Central Maine Healthcare Corporation
Philippe Morissette, VP of Finance
(207) 795-2972

Primary Contact

Central Maine Healthcare
Sean Cheetham, Taxation Manager
(207) 795-7533

Addresses

Street Address

33 Bath Road
Brunswick, ME 04011

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
		1689653487

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
DSH200024AB	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Brunswick Family Medicine	33 Bath Road	Brunswick	ME	Terminated
DSH200024AC	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Brunswick Primary Care	329 Maine Street	Brunswick	ME	Terminated
DSH200024AE	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Bariatric Surgery	10 High Street	Lewiston	ME	Terminated
DSH200024AG	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Minot Avenue Family Medicine	789 Minot Avenue	Auburn	ME	Active
DSH200024AH	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Bladder Control Center	287 Main Street	Lewiston	ME	Terminated
DSH200024AI	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Bariatric	10 High Street	Lewiston	ME	Terminated
DSH200024AJ	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Pulmonology	76 HIGH STREET	Lewiston	ME	Active
DSH200024AK	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Topsham Endocrinology, Diabetes & Infectious Disease	4 Horton Place	Topsham	ME	Terminated
DSH200024AL	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Topsham Coastal Plastic Surgery	4 Horton Place	Topsham	ME	Terminated
DSH200024AM	Child	DSH	CENTRAL MAINE MEDICAL CENTER	High Street Family Medicine	10 High Street	Lewiston	ME	Terminated
DSH200024AN	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CMMC Physical Therapy	77 Bates Street	Lewiston	ME	Terminated
DSH200024AP	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Medication Management Clinic	10 High Street	Lewiston	ME	Active
DSH200024AQ	Child	DSH	CENTRAL MAINE MEDICAL CENTER	AUGUSTA INTERNAL MEDICINE - Internal Medicine	12 SPRUCE STREET STE 7	AUGUSTA	ME	Terminated
DSH200024AR	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE RHEUMATOLOGY - Rheumatology	685 Sabattus ST	LEWISTON	ME	Active
DSH200024AS	Child	DSH	CENTRAL MAINE MEDICAL CENTER	TOPSHAM CARE CTR SPECIALTY CLINIC	105 TOPSHAM FAIR MALL ROAD	TOPSHAM	ME	Active
DSH200024AT	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE RADIATION ONCOLOGY - ONCOLOGY	17 HIGH STREET	LEWISTON	ME	Active
DSH200024AU	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE BREAST HEALTH - MAMMOGRAPHY	17 HIGH STREET	LEWISTON	ME	Active
DSH200024AV	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE HEMATOLOGY/ONCOLOGY - Hematology and Oncology	17 High Street	LEWISTON	ME	Active
DSH200024AW	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE INFUSION CENTER - MEDICAL ONCOLOGY	17 High Street	LEWISTON	ME	Active
DSH200024AX	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE SURGICAL ONCOLOGY - SURGICAL ONCOLOGY	17 HIGH STREET	LEWISTON	ME	Active
DSH200024AY	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Therapy Services PT - Physical Therapy	17 High Street	Lewiston	ME	Terminated
DSH200024AZ	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Therapy Services OT - Occupational Therapy	17 High Street	Lewiston	ME	Terminated
DSH200024B	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Heart Associates - Brunswick	329 Maine Street	Brunswick	ME	Terminated
DSH200024BA	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE OBSTETRICS-GYNECOLOGY - Obstetrics Gynecology	12 HIGH ST	LEWISTON	ME	Active
DSH200024BB	Child	DSH	CENTRAL MAINE MEDICAL CENTER	BENNETT BREAST CARE CENTER - Breast Care	12 HIGH STREET	LEWISTON	ME	Active
DSH200024BC	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE FAMILY PRACTICE - Family Practice	12 HIGH STREET	LEWISTON	ME	Active
DSH200024BD	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE EAR, NOSE AND THROAT - ENTEROLOGY	12 HIGH STREET SUITE 102	LEWISTON	ME	Active
DSH200024BE	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE INTERNAL MEDICINE - Internal Medicine	12 HIGH STREET SUITE 400	LEWISTON	ME	Active
DSH200024BF	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE PEDIATRICS - PEDIATRICS	12 HIGH STREET SUITE 302	LEWISTON	ME	Active
DSH200024BG	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE SURGICAL ASSOCIATES - Surgical	12 HIGH STREET	LEWISTON	ME	Active
DSH200024BH	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE SLEEP MEDICINE - Sleep Medicine	300 MAIN ST	LEWISTON	ME	Active
DSH200024BJ	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRALMAINE HEALTHCARE ORTHOPEDICS - Orthopedics	690 MINOT AVE	AUBURN	ME	Active
DSH200024BK	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE GYNECOLOGIC ONCOLOGY - ONCOLOGY	17 HIGH ST	LEWISTON	ME	Active
DSH200024BL	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE MEDICAL CENTER - Infusion and Specialty Services - Specialty Services	685 Sabattus ST	LEWISTON	ME	Active
DSH200024C	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Gynecology and Urogynecology	287 Main Street	Lewiston	ME	Terminated
DSH200024D	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Pain and Headache Center - Wiscasset	721 Bath Road	Wiscasset	ME	Terminated
DSH200024E	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE UROLOGY	12 High Street	Lewiston	ME	Active
DSH200024G	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Topsham Family Medicine	4 Horton Place	Topsham	ME	Active
DSH200024H	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Sports Medicine	77 Bates Street	Lewiston	ME	Terminated
DSH200024J	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Poland Community Health Center	364 Maine Street	Poland	ME	Terminated
DSH200024K	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Plastic Surgery	287 Main Street	Lewiston	ME	Terminated
DSH200024L	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Pain & Headache Center - Lewiston	77 Bates Street	Lewiston	ME	Terminated
DSH200024N	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE NEUROLOGY	10 High Street	Lewiston	ME	Active
DSH200024P	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Mechanic Falls Family Practice	22 Pleasant Street	Mechanic Falls	ME	Terminated
DSH200024Q	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Lisbon Family Practice	2 Bisbee Street	Lisbon	ME	Terminated
DSH200024R	Child	DSH	CENTRAL MAINE MEDICAL CENTER	CENTRAL MAINE INFECTIOUS DISEASES	10 HIGH ST	Lewiston	ME	Active
DSH200024S	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Gray Family Health	126 Shaker Road	Gray	ME	Active
DSH200024T	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Gastroenterology	77 Bates Street	Lewiston	ME	Active
DSH200024U	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Family Medicine Residency	76 High Street	Lewiston	ME	Active
DSH200024V	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Family Health Associates	190 Stetson Road	Auburn	ME	Active
DSH200024W	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Endocrinology and Diabetes Center	76 High Street	Lewiston	ME	Active
DSH200024X	Child	DSH	CENTRAL MAINE MEDICAL CENTER	Central Maine Heart Associates - Auburn	2 Great Falls Plaza	Auburn	ME	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Cheetham, Sean Taxation Manager Central Maine Medical Center 2077957533	Cheetham, Sean Taxation Manager Central Maine Healthcare 2077957533	1/15/2018 9:20 AM
Contacts	Primary Contact	Update		Cheetham, Sean Taxation Manager 2077957533	Cheetham, Sean Taxation Manager Central Maine Medical Center 2077957533	10/2/2017 8:50 AM
Contacts	Authorizing Official	Update	Profile Change Request	Morissette, Philippe VP of Finance 200024 2077952972	Morissette, Philippe VP of Finance Central Maine Healthcare Corporation 2077952972	9/29/2017 6:13 PM
Contacts	Signed By	Update	Profile Change Request	Morissette, Philippe VP of Finance 200024 2077952972	Morissette, Philippe VP of Finance Central Maine Healthcare Corporation 2077952972	9/29/2017 6:13 PM
Contacts	Authorizing Official	Update		Morissette, Philippe VP of Finance 2077952972	Morissette, Philippe VP of Finance 200024 2077952972	9/29/2017 5:57 PM
Contacts	Signed By	Update		Morissette, Philippe VP of Finance 2077952972	Morissette, Philippe VP of Finance 200024 2077952972	9/29/2017 5:57 PM
Contacts	Authorizing Official	Insert			Morissette, Philippe VP of Finance 2077952972	8/8/2017 6:30 AM
Contacts	Signed By	Insert			Morissette, Philippe VP of Finance 2077952972	8/8/2017 6:30 AM
Contacts	Primary Contact	Insert			Cheetham, Sean Taxation Manager 2077957533	8/1/2017 3:20 PM
Addresses	Main Address	Insert			33 Bath Road Brunswick, ME 04011	12/3/2015 10:48 AM
Dates	Last Date That 340B Drugs Purchased	Update			11/30/2015 12:00:00 AM	12/3/2015 10:48 AM
Details	State	Update		Active	Terminated	12/3/2015 10:48 AM
Terminations	Termination Comments	Update			Please contact Philippe Morissette with any questions.	12/3/2015 10:48 AM
Terminations	Termination Date	Update			1/1/2016 12:00:00 AM	12/3/2015 10:48 AM
Terminations	Termination Effective Date	Update			11/30/2015 12:00:00 AM	12/3/2015 10:48 AM
Terminations	Termination Reason	Update			DSH percentage below statutory minimum	12/3/2015 10:48 AM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/6/2015 8:29 AM
Details	Last Recertification Date	Update			8/27/2014 12:00:00 AM	8/27/2014 10:03 AM
Dates	Participating Approval Date	Update			2/27/2014 12:00:00 AM	2/27/2014 10:40 PM
Details	State	Update		Pending	Active	2/27/2014 10:40 PM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	2/27/2014 10:40 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DSH200024AB	2/27/2014 4:01 PM
Medicaid Billing	NPI: Number	Insert			1689653487	1/10/2014 10:01 AM
Details	Last Recertification Date	Insert				1/10/2014 10:01 AM
Details	Grant Number	Insert				1/10/2014 10:01 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/10/2014 10:01 AM
Details	Is Authorizing Official EHB Data	Insert				1/10/2014 10:01 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/10/2014 10:01 AM
Details	Medicare Provider Number	Insert			200024	1/10/2014 10:01 AM
Details	Entity Name	Insert			CENTRAL MAINE MEDICAL CENTER	1/10/2014 10:01 AM
Details	Program Code	Insert			DSH	1/10/2014 10:01 AM
Details	Entity Subname	Insert			Brunswick Family Medicine	1/10/2014 10:01 AM
Dates	Participating Approval Date	Insert				1/10/2014 10:01 AM
Details	State	Insert			Pending	1/10/2014 10:01 AM
Dates	Registration Date	Insert			1/10/2014 12:00:00 AM	1/10/2014 10:01 AM
Dates	Signed By Date	Insert			1/10/2014 12:00:00 AM	1/10/2014 10:01 AM
Dates	Start Date	Insert				1/10/2014 10:01 AM
Terminations	Termination Comments	Insert				1/10/2014 10:01 AM
Terminations	Termination Date	Insert				1/10/2014 10:01 AM
Terminations	Termination Effective Date	Insert				1/10/2014 10:01 AM
Terminations	Termination Reason	Insert				1/10/2014 10:01 AM