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DSH200039DL MAINEGENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
MaineGeneral Express Care-Winthrop - Express Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200039DL
Medicare Provider Number
200039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/12/2024
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
MaineGeneral Medical Center
Terrance Brann, Chief Financial Officer
(207) 623-6624
Primary Contact
MaineGeneral Medical Center
Jennifer A Kent, 340B Coordinator
(207) 248-5160
Addresses
Street Address
Winthrop Commerce Center
16 Commerce Plaza, Suite 3A
Winthrop, ME 04364
Billing Address
MaineGeneral Medical Center
35 Medical Center Parkway
ATTN: Accounts Payable
Augusta, ME 04330
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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