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DSH200033R EASTERN MAINE MEDICAL CENTER (Active)
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Main Details
Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
Urologic Surgery of Maine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200033R
Medicare Provider Number
200033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/7/2013
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Eastern Maine Medical Center
Randy Brian Albert, VP Finance
(207) 973-4279
Primary Contact
Eastern Maine Medical Center
Lynn Thornton, Director of Pharmacy
(207) 973-9012
Addresses
Street Address
55 Broadway, Suite 2
Bangor, ME 04401
Billing Address
Eastern Maine Medical Center
489 State Street
Bangor, ME 04401
Comments
Medicaid Billing
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Contract Pharmacies
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