Covered Entity Details

CAH201302-06 Lincoln Hospital (Active) - information as of 5/10/2025 10:45:18 PM

Main Details

Name

Lincoln Hospital

Subdivision Name

LMP FAMILY CARE CENTER

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH201302-06

Medicare Provider Number

201302

Outpatient Facility Provider Number

203975

Additional Details

Current Program Status

Active

Registration Date

4/13/2015

Participating Start Date

7/1/2015

Participating Approval Date

5/19/2015

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

Lincoln Hospital
Wayne R Printy, CFO
(207) 563-4476

Primary Contact

Lincoln Hospital
Karen Philbrick, Pharmacy Director
(207) 563-4487

Addresses

Street Address

19 St. Andrews Lane
BOOTHBAY HARBOR, ME 04538-1732

Billing Address

LincolnHealth
P.O. Box 745
Newcastle, ME 04553

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	1881709202	1881709202

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
CAH201302-01	Child	CAH	Lincoln Hospital	Urgent Care Center	6 St. Andrews Lane	Boothbay Harbor	ME	Active
CAH201302-02	Child	CAH	Lincoln Hospital	LMP FAMILY MEDICINE WALDOBORO	592 W. MAIN ST	WALDOBORO	ME	Active
CAH201302-03	Child	CAH	St. Andrews Hospital	LMP FAMILY MEDICINE	24 Miles Center Way	DAMARISCOTTA	ME	Terminated
CAH201302-04	Child	CAH	Lincoln Hospital	LMP PRIMARY CARE DAMARISCOTTA	24 Miles Center Way	DAMARISCOTTA	ME	Active
CAH201302-05	Child	CAH	St. Andrews Hospital	LMP PEDIATRICS	24 Miles Center Way	DAMARISCOTTA	ME	Terminated
CAH201302-06	Child	CAH	Lincoln Hospital	LMP FAMILY CARE CENTER	19 St. Andrews Lane	BOOTHBAY HARBOR	ME	Active
CAH201302-07	Child	CAH	Lincoln Hospital	LMP WOUND CARE	19 St. Andrews Lane	BOOTHBAY HARBOR	ME	Active
CAH201302-08	Child	CAH	Lincoln Hospital	LMP WOMEN'S CENTER	24 MILES CENTER WAY	DAMARISCOTTA	ME	Active
CAH201302-09	Child	CAH	Lincoln Hospital	LMP GENERAL SURGERY	24 MILES CENTER WAY	DAMARISCOTTA	ME	Active
CAH201302-10	Child	CAH	Lincoln Hospital	LMP ORTHOPEDICS	24 Miles Center Way	DAMARISCOTTA	ME	Active
CAH201302-11	Child	CAH	Lincoln Hospital	LMP Ophthalmology - Ophthalmology	5 Miles Center Way	Damariscotta	ME	Active
CAH201302-12	Child	CAH	Lincoln Hospital	LMP Oncology Damariscotta - Oncology	24 Miles Center Way	Damariscotta	ME	Active
CAH201302-13	Child	CAH	Lincoln Hospital	LMP Cardiology Damariscotta - Cardiology	24 Miles Center Way	Damariscotta	ME	Active
CAH201302-14	Child	CAH	Lincoln Hospital	LMP Otolaryngology - Otolaryngology	24 Miles Center Way	Damariscotta	ME	Active
CAH201302-15	Child	CAH	Lincoln Hospital	LMP Urology - Urology	24 Miles Center Way	Damariscotta	ME	Active
CAH201302-16	Child	CAH	Lincoln Hospital	LMP Dermatology - Dermatology	24 Miles Center Way	Damariscotta	ME	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Printy, Wayne R CFO LincolnHealth 2075634476	Printy, Wayne R CFO Lincoln Hospital 2075634476	3/24/2025 8:01 AM
Details	Entity Name	Update	Change Request	MaineHealth	Lincoln Hospital	3/24/2025 8:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Philbrick, Karen Pharmacy Director MaineHealth D/B/A LincolnHealth 2075634487	Philbrick, Karen Pharmacy Director Lincoln Hospital 2075634487	3/19/2025 8:08 AM
Details	Last Recertification Date	Update	Recertification	8/14/2023 1:14:45 PM	8/23/2024 4:50:23 AM	8/23/2024 4:50 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 10:44:20 AM	8/14/2023 1:14:45 PM	8/14/2023 1:14 PM
Contacts	Primary Contact	Update	Group Change Request	Hoang, Minh Director of 340B and Drug Supply Management Maine Health 2076628064	Philbrick, Karen Pharmacy Director MaineHealth D/B/A LincolnHealth 2075634487	11/29/2022 6:24 AM
Details	Last Recertification Date	Update	Recertification	8/20/2021 6:39:24 AM	8/26/2022 10:44:20 AM	8/26/2022 10:44 AM
Contacts	Primary Contact	Update	Group Change Request	Philbrick, Karen Director of Pharmacy LincolnHealth 2075634487	Hoang, Minh Director of 340B and Drug Supply Management Maine Health 2076628064	7/13/2022 1:12 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 8:18:28 AM	8/20/2021 6:39:24 AM	8/20/2021 6:39 AM
Medicaid Billing	NPI: State	Update	Recertification		ME	8/19/2020 8:18 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 6:35:19 AM	8/19/2020 8:18:28 AM	8/19/2020 8:18 AM
Details	Entity Name	Update	Recertification	LincolnHealth	MaineHealth	9/4/2019 12:09 PM
Addresses	Main Address	Update	Recertification	19 SAINT ANDREWS LN BOOTHBAY HARBOR, ME 04538-1732	19 St. Andrews Lane BOOTHBAY HARBOR, ME 04538-1732	8/28/2019 6:35 AM
Details	Last Recertification Date	Update	Recertification	8/23/2018 12:51:16 PM	8/28/2019 6:35:19 AM	8/28/2019 6:35 AM
Details	Entity Name	Update	Change Request	St. Andrews Hospital	LincolnHealth	1/9/2019 1:21 PM
Contacts	Authorizing Official	Update	Profile Change Request	Printy, Wayne wayne.printy@lchcare.org CFO wayne.printy@lchcare.org 2075634476	Printy, Wayne R CFO LincolnHealth 2075634476	1/8/2019 1:56 PM
Contacts	Signed By	Update	Profile Change Request	Printy, Wayne wayne.printy@lchcare.org CFO wayne.printy@lchcare.org 2075634476	Printy, Wayne R CFO LincolnHealth 2075634476	1/8/2019 1:56 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1881709202	10/18/2018 5:22 AM
Details	Last Recertification Date	Update	Recertification	11/9/2017 5:42:59 AM	8/23/2018 12:51:16 PM	8/23/2018 12:51 PM
Details	Entity Name	Update	Recertification	ST ANDREWS HOSPITAL	St. Andrews Hospital	11/15/2017 12:36 PM
Details	Last Recertification Date	Update	Recertification	8/22/2016 12:00:00 AM	11/9/2017 5:42:59 AM	11/9/2017 5:42 AM
Contacts	Authorizing Official	Update		Printy, Wayne CFO 2075634476	Printy, Wayne wayne.printy@lchcare.org CFO wayne.printy@lchcare.org 2075634476	10/12/2017 10:44 AM
Contacts	Signed By	Update		Printy, Wayne CFO 2075634476	Printy, Wayne wayne.printy@lchcare.org CFO wayne.printy@lchcare.org 2075634476	10/12/2017 10:44 AM
Contacts	Primary Contact	Update		Philbrick, Karen Director of Pharmacy 2075634487	Philbrick, Karen Director of Pharmacy LincolnHealth 2075634487	10/10/2017 9:16 AM
Contacts	Primary Contact	Insert			Philbrick, Karen Director of Pharmacy 2075634487	8/22/2016 11:30 AM
Contacts	Authorizing Official	Insert			Printy, Wayne CFO 2075634476	8/22/2016 11:30 AM
Contacts	Signed By	Insert			Printy, Wayne CFO 2075634476	8/22/2016 11:30 AM
Addresses	Main Address	Insert			19 SAINT ANDREWS LN BOOTHBAY HARBOR, ME 04538-1732	8/22/2016 9:30 AM
Details	Last Recertification Date	Update		8/18/2015 12:00:00 AM	8/22/2016 12:00:00 AM	8/22/2016 9:30 AM
Details	Last Recertification Date	Update			8/18/2015 12:00:00 AM	8/18/2015 10:57 AM
Addresses	Billing Address	Insert			LincolnHealth P.O. Box 745 Newcastle, ME 04553	5/19/2015 3:30 PM
Dates	Participating Approval Date	Update			5/19/2015 12:00:00 AM	5/19/2015 3:27 PM
Details	State	Update		Pending	Active	5/19/2015 3:27 PM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	5/19/2015 3:27 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_51175	CAH201302-06	4/15/2015 2:41 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_51175	4/13/2015 10:05 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/13/2015 10:05 AM
Medicaid Billing	Medicaid: Number	Insert			1881709202	4/13/2015 10:05 AM
Medicaid Billing	Medicaid: State	Insert			ME	4/13/2015 10:05 AM
Details	Last Recertification Date	Insert				4/13/2015 10:05 AM
Details	Grant Number	Insert				4/13/2015 10:05 AM
Details	340B ID	Insert				4/13/2015 10:05 AM
Details	Is Authorizing Official EHB Data	Insert				4/13/2015 10:05 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/13/2015 10:05 AM
Details	Medicare Provider Number	Insert			201302	4/13/2015 10:05 AM
Details	Entity Name	Insert			ST ANDREWS HOSPITAL	4/13/2015 10:05 AM
Details	Program Code	Insert			CAH	4/13/2015 10:05 AM
Details	Entity Subname	Insert			LMP FAMILY CARE CENTER	4/13/2015 10:05 AM
Dates	Participating Approval Date	Insert				4/13/2015 10:05 AM
Details	State	Insert			Pending	4/13/2015 10:05 AM
Dates	Registration Date	Insert			4/13/2015 12:00:00 AM	4/13/2015 10:05 AM
Dates	Signed By Date	Insert			4/13/2015 12:00:00 AM	4/13/2015 10:05 AM
Dates	Start Date	Insert				4/13/2015 10:05 AM
Terminations	Termination Comments	Insert				4/13/2015 10:05 AM
Terminations	Termination Date	Insert				4/13/2015 10:05 AM
Terminations	Termination Effective Date	Insert				4/13/2015 10:05 AM
Terminations	Termination Reason	Insert				4/13/2015 10:05 AM