340B Drug Pricing Program Database
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DSH200050T MAINE COAST MEMORIAL HOSPITAL (Approved)
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Main Details
Name
MAINE COAST MEMORIAL HOSPITAL
Subdivision Name
ELEANOR WIDENER DIXON MEMORIAL CLIN - Primary Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200050T
Medicare Provider Number
200050
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/15/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/24/2025
Last Recertification Date
Contacts
Authorizing Official
Maine Coast Hospital
Wendy June Merchant, VP of Finance
(207) 610-2429
Primary Contact
Northern Light Health
Corey Michael Taylor, Director of Pharmacy
(207) 664-5468
Addresses
Street Address
37 CLINIC RD
GOULDSBORO, ME 04607-4013
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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