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DSH200033BB EASTERN MAINE MEDICAL CENTER (Approved)
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Main Details
Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
Northern Light Urology - Urology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200033BB
Medicare Provider Number
200033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/15/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/22/2025
Last Recertification Date
Contacts
Authorizing Official
Eastern Maine Medical Center
Randy Brian Albert, VP Finance
(207) 973-4279
Primary Contact
Eastern Maine Medical Center
Lynn Thornton, Director of Pharmacy
(207) 973-9012
Addresses
Street Address
404 State Street
610
Bangor, ME 04401
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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