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CH01458J PENOBSCOT COMMUNITY HEALTH CENTER, INC. (Terminated)
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Main Details
Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
Subdivision Name
BANGOR AREA HOMELESS SHELTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-006681
340B ID
CH01458J
Grant Number
H80CS04291
Additional Details
Current Program Status
Terminated
Registration Date
11/20/2006
Participating Start Date
7/1/2004
Participating Approval Date
11/20/2006
Last Recertification Date
2/9/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Penobscot Community Health Center Inc.
Lorelle Dwyer, President & CEO
(207) 992-9200
Primary Contact
Penobscot Community Health Center Inc
Frank R McGrady, Executive Clinical Director of Pharmacy
(207) 992-9200 Ext: 1539
Addresses
Street Address
26 CEDAR ST
BANGOR, ME 04401
Billing Address
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
PO BOX 2100
BANGOR, ME 04402-2100
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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12/1/06 UPDATED MEDICAID # (WAS 131160200)
01/21/2010
April 2025
April 2025
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