340B Drug Pricing Program Database
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DSH200008AY MERCY HOSPITAL (Approved)
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Main Details
Name
MERCY HOSPITAL
Subdivision Name
Northern Light Mercy Wound Care - Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200008AY
Medicare Provider Number
200008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/7/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/17/2025
Last Recertification Date
Contacts
Authorizing Official
Mercy Hospital
David Kennedy, VP of Finance
(207) 879-3363
Primary Contact
Northern Light Health
Amy Gamble, Director - 340B Program
(978) 549-5617
Addresses
Street Address
155 Fore River Parkway
Portland, ME 04102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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