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CH01458D PENOBSCOT COMMUNITY HEALTH CENTER, INC. (Active)
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Main Details
Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
Subdivision Name
COMMUNITY CARE AND GERIATRICS
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001061
340B ID
CH01458D
Grant Number
H80CS04291
Additional Details
Current Program Status
Active
Registration Date
1/1/2005
Participating Start Date
1/1/2005
Participating Approval Date
12/6/2004
Last Recertification Date
3/6/2025
Contacts
Authorizing Official
Penobscot Community Health Center Inc.
Lorelle Dwyer, President & CEO
(207) 992-9200
Primary Contact
Penobscot Community Health Care
Meagan Rusby, Associate Director of Pharmacy
(207) 992-9200 Ext: 1764
Addresses
Street Address
992 UNION ST
BANGOR, ME 04401
Billing Address
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
103 Maine Ave
BANGOR, ME 04401-2100
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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5/4/09 PHYS & BILL ADDR CHANGE (WAS 1048 UNION STREET, SUITE 3)- 12/1/06 - ADDED MEDICAID #
05/04/2009
April 2025
April 2025
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