340B Drug Pricing Program Database


DSH200063AL PENOBSCOT BAY MEDICAL CENTER (Active) - information as of 5/3/2025 11:31:37 PM

Main Details
PENOBSCOT BAY MEDICAL CENTER
PBPA PULMONOLOGY - Pulmonology
Disproportionate Share Hospital
Yes
DSH200063AL
200063


Additional Details
Active
1/13/2022
4/1/2022
1/24/2022
8/24/2024

Contacts

Coastal Healthcare Alliance
Heather Shanklin, Chief Financial Officer
(207) 505-4131

Coastal Health Alliance, MaineHealth
David MacMillan, Pharmacy Director
(207) 301-8563

Addresses

4 Glen Cove Dr
Suite 200
Rockport, ME 04856

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
ME 1982645305,1578043378
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH200063AChildDSHPENOBSCOT BAY MEDICAL CENTERWaldoboro Family Medicine27 Mill StreetWaldoboroMEActive
DSH200063AAChildDSHPENOBSCOT BAY MEDICAL CENTERPEN BAY PODIATRY4 Glen Cove Drive, Suite 205RockportMEActive
DSH200063ABChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Surgical Skin Center731 Commercial StreetRockportMETerminated
DSH200063ACChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Skin Center8 Wellness AvenueRockportMEActive
DSH200063ADChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Gastroenterology4 Glen Cove Dr.RockportMEActive
DSH200063AEChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Wound Healing Center4 Glen Cove Drive, Suite 103RockportMEActive
DSH200063AFChildDSHPENOBSCOT BAY MEDICAL CENTERPBMC ANTICOAG CLINIC - Anticoagulation Clinic4 Glen Cove DrRockportMEActive
DSH200063AGChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA Nephrology - Nephrology15 Anchor DriveRockportMEActive
DSH200063AHChildDSHPENOBSCOT BAY MEDICAL CENTERPBMC DIABETES & NUTRITION CARE CENTER - Diabetes and Nutrition4 Glen Cove DrRockportMEActive
DSH200063AJChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA PALLIATIVE CARE - Palliative Care4 Glen Cove DrRockportMEActive
DSH200063AKChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA RESPIRATORY HEALTH CENTER - Respiratory731 Commercial StreetRockportMETerminated
DSH200063ALChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA PULMONOLOGY - Pulmonology4 Glen Cove DrRockportMEActive
DSH200063AMChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA PRIMARY CARE ROCKLAND - PRIMARY CARE75 Maverick StRocklandMEActive
DSH200063ANChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA WALK IN CLINIC - WALK IN CARE75 Maverick StRocklandMEActive
DSH200063APChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA PAIN MANAGEMENT AND PHYSICAL MEDICINE - Physical Medicine & Interventional Pain Management4 Glen Cove DrRockportMETerminated
DSH200063AQChildDSHPENOBSCOT BAY MEDICAL CENTERPBPA Dermatology - Dermatology8 Wellness AveRockportMEActive
DSH200063ARChildDSHPENOBSCOT BAY MEDICAL CENTERMaineHealth Cardiology-Rockport - Cardiology4 Glen Cove DrRockportMEApproved
DSH200063CChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Surgery4 Glen Cove Drive, Suite 103RockportMEActive
DSH200063FChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Internal Medicine15 Anchor Drive, Suite 202RockportMEActive
DSH200063GChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Neurology4 Glen Cove Drive, Suite 201RockportMEActive
DSH200063HChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Urology3 Glen Cove Drive, Suite 3RockportMEActive
DSH200063JChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Women's Health3 Glen Cove Drive, Suite 1RockportMEActive
DSH200063KChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Pediatrics15 Anchor Drive, Suite 103RockportMEActive
DSH200063LChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Speech and Hearing/Pediatric PT and OT15 Anchor Drive, Suite 104RockportMETerminated
DSH200063MChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Specialty Clinic79 Schooner Street, Suite 1DamariscottaMETerminated
DSH200063NChildDSHPENOBSCOT BAY MEDICAL CENTERCenter for Sleep Medicine7 Madelyn Lane Suite 100RockportMETerminated
DSH200063PChildDSHPENOBSCOT BAY MEDICAL CENTERDr. Robert Merrill MD Family Medicine821 Commercial Street, Unit 3RockportMETerminated
DSH200063QChildDSHPENOBSCOT BAY MEDICAL CENTERDr. Robert Laurence MD Internal Medicine760 Commercial StreetRockportMEActive
DSH200063RChildDSHPENOBSCOT BAY MEDICAL CENTERDr. Parker Chamberlain MD ENT4 Glen Cove Drive, Suite 207RockportMETerminated
DSH200063SChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay ENT15 Anchor Drive, Suite 102RockportMEActive
DSH200063TChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Physical Therapy - Waldoboro40 Washington StreetWaldoboroMETerminated
DSH200063UChildDSHPENOBSCOT BAY MEDICAL CENTERPT YMCA Clinic116 Union StreetRockportMETerminated
DSH200063VChildDSHPENOBSCOT BAY MEDICAL CENTEROutpatient PT OT PBMC4 Glen Cove Drive, Suite 109RockportMETerminated
DSH200063WChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Orthopedics4 Glen Cove Drive, Suite 206RockportMEActive
DSH200063XChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Family Medicine15 Anchor Drive, Suite 201RockportMEActive
DSH200063YChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Medicine and Infectious Diseases4 Glen Cove Drive, Suite 102RockportMEActive
DSH200063ZChildDSHPENOBSCOT BAY MEDICAL CENTERPen Bay Rheumatology4 Glen Cove, STE 202ROCKPORTMEActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/29/2023 8:31:25 AM8/24/2024 10:15:59 AM8/24/2024 10:15 AM
Medicaid BillingNPI: NumberInsertChange Request 157804337810/19/2023 8:27 AM
Medicaid BillingNPI: StateInsertChange Request ME10/19/2023 8:27 AM
DetailsLast Recertification DateUpdateRecertification8/29/2022 8:13:34 AM8/29/2023 8:31:25 AM8/29/2023 8:31 AM
ContactsPrimary ContactUpdateGroup Change RequestHoang, Minh Director of 340B and Drug Supply Management Maine Health 2076628064MacMillan, David Pharmacy Director Coastal Health Alliance, MaineHealth 207301856311/28/2022 4:01 PM
DetailsLast Recertification DateUpdateRecertification 8/29/2022 8:13:34 AM8/29/2022 8:13 AM
DetailsStateUpdate ApprovedActive4/1/2022 12:01 AM
ContactsAuthorizing OfficialUpdateChange RequestDrinkwater, Linda CFO Waldo County General Hospital 2075054104Shanklin, Heather Chief Financial Officer Coastal Healthcare Alliance 20750541311/24/2022 1:29 PM
ContactsSigned ByInsertNew Registration Drinkwater, Linda CFO Waldo County General Hospital 20750541041/24/2022 8:16 AM
Details340B IDUpdateNew Registration DSH200063AL1/24/2022 8:16 AM
DetailsEntity SubnameUpdateNew RegistrationPBPA PULMONOLOGYPBPA PULMONOLOGY - Pulmonology1/24/2022 8:16 AM
DatesParticipating Approval DateUpdateNew Registration 1/24/2022 8:16:09 AM1/24/2022 8:16 AM
DetailsStateUpdateNew RegistrationPendingApproved1/24/2022 8:16 AM
DatesSigned By DateUpdateNew Registration 1/21/2022 3:42:42 PM1/24/2022 8:16 AM
DatesStart DateUpdateNew Registration 4/1/2022 12:00:00 AM1/24/2022 8:16 AM
AddressesMain AddressInsertNew Registration  4 Glen Cove Dr Suite 200 Rockport, ME 048561/13/2022 3:53 PM
Medicaid BillingNPI: NumberInsertNew Registration 19826453051/13/2022 3:53 PM
Medicaid BillingNPI: StateInsertNew Registration ME1/13/2022 3:53 PM
ContactsAuthorizing OfficialInsertNew Registration Drinkwater, Linda CFO Waldo County General Hospital 20750541041/13/2022 3:53 PM
ContactsPrimary ContactInsertNew Registration Hoang, Minh Director of 340B and Drug Supply Management Maine Health 20766280641/13/2022 3:53 PM
DetailsAssistance Received From DateInsertNew Registration  1/13/2022 3:53 PM
DetailsAssistance Received To DateInsertNew Registration  1/13/2022 3:53 PM
DetailsLast Recertification DateInsertNew Registration  1/13/2022 3:53 PM
DetailsGrant NumberInsertNew Registration  1/13/2022 3:53 PM
Details340B IDInsertNew Registration  1/13/2022 3:53 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/13/2022 3:53 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/13/2022 3:53 PM
DetailsMedicare Provider NumberInsertNew Registration 2000631/13/2022 3:53 PM
DetailsEntity NameInsertNew Registration PENOBSCOT BAY MEDICAL CENTER1/13/2022 3:53 PM
DetailsNOFO NumberInsertNew Registration  1/13/2022 3:53 PM
DetailsProgram CodeInsertNew Registration DSH1/13/2022 3:53 PM
DetailsEntity SubnameInsertNew Registration PBPA PULMONOLOGY1/13/2022 3:53 PM
DatesParticipating Approval DateInsertNew Registration  1/13/2022 3:53 PM
DetailsStateInsertNew Registration Pending1/13/2022 3:53 PM
DatesRegistration DateInsertNew Registration 1/13/2022 3:53:44 PM1/13/2022 3:53 PM
DatesSigned By DateInsertNew Registration  1/13/2022 3:53 PM
DatesStart DateInsertNew Registration  1/13/2022 3:53 PM
TerminationsTermination CommentsInsertNew Registration  1/13/2022 3:53 PM
TerminationsTermination DateInsertNew Registration  1/13/2022 3:53 PM
TerminationsTermination Effective DateInsertNew Registration  1/13/2022 3:53 PM
TerminationsTermination ReasonInsertNew Registration  1/13/2022 3:53 PM