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DSH200063 PENOBSCOT BAY MEDICAL CENTER (Active)
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Main Details
Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200063
Medicare Provider Number
200063
Additional Details
Current Program Status
Active
Registration Date
8/29/2005
Participating Start Date
4/1/2006
Participating Approval Date
3/7/2006
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Coastal Healthcare Alliance
Heather Shanklin, Chief Financial Officer
(207) 505-4131
Primary Contact
Coastal Health Alliance, MaineHealth
David MacMillan, Pharmacy Director
(207) 301-8563
Addresses
Street Address
6 Glen Cove Dr
Rockport, ME 04856
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/3/2010-DOC RECD TO CONFIRM ELIG DSH ADJ %; 8/28/08-DOC RECD TO CONFIRM ELIG DSH ADJ %; REINSTATED 4/1/06 WITH NEW MEDICAID # (OLD # WAS 104540000), PARTICIPATED 9/9/05 TO 12/31/05
03/03/2010
April 2025
April 2025
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