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DSH200041 INLAND HOSPITAL (ToBeTerminated)
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Main Details
Name
INLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200041
Medicare Provider Number
200041
Additional Details
Current Program Status
ToBeTerminated
Registration Date
6/11/2008
Participating Start Date
7/1/2008
Participating Approval Date
6/11/2008
Last Recertification Date
8/30/2024
Termination Date
Termination Reason
7/1/2025
Site closure
Contacts
Authorizing Official
Mercy Hospital
David Kennedy, VP of Finance
(207) 879-3363
Primary Contact
Northern Light Inland Hospital
Jessica Pelotte, Director of Pharmacy
(207) 861-3380
Addresses
Street Address
200 KENNEDY MEMORIAL DRIVE
WATERVILLE, ME 04901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/17/2010- OPA NOTIFIED AND RECD. DOCUMENTATION ON 3/5/2010 CONFIRMING DSH ADJ. %. 03/20/2014: Termination recorded in error; site remained continuously eligible from participation start date.
03/31/2014
3/17/2010- OPA NOTIFIED AND RECD. DOCUMENTATION ON 3/5/2010 CONFIRMING DSH ADJ. %.
03/17/2010
June 2025
June 2025
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