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DSH200001 ST JOSEPH HOSPITAL (Active)
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Main Details
Name
ST JOSEPH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200001
Medicare Provider Number
200001
Additional Details
Current Program Status
Active
Registration Date
10/14/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/30/2024
Last Recertification Date
Contacts
Authorizing Official
St. Joseph Hospital
Michael Allan Hendrix, Vice of President of Finance
(207) 907-1600
Primary Contact
St. Joseph Hospital
Courtney Mcvey, Pharmacy Operations Manager
(207) 907-1823
Addresses
Street Address
360 BROADWAY
BANGOR, ME 04401
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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