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DSH200052 NORTHERN MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
NORTHERN MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200052
Medicare Provider Number
200052
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/18/2023
Last Recertification Date
8/27/2024
Termination Date
Termination Reason
12/6/2024
Other
Contacts
Authorizing Official
Northern Maine Medical Center
Alain Bois, Chief Operating Officer
(207) 834-1411
Primary Contact
Northern Maine Medical Center
Jordan Albert, Director of Pharmacy
(207) 834-1632
Addresses
Street Address
194 EAST MAIN STREET
FORT KENT, ME 04743
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2008, terminated 10/1/2014. Reinstated 4/1/2023.
01/18/2023
4/8/08- DOC RECD TO CONFIRM ELIG DSH ADJ %; 1/1/08 REINSTATED PREV PART FROM 10/1/06 THROUGH 9/30/07, INELIG 10/1/07 TO 12/31/07, REMOVED MEDICAID # (WAS 102460000)
06/10/2008
April 2025
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