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DSH200009AN MAINEHEALTH MAINE MEDICAL CENTER (Active)
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Main Details
Name
MAINEHEALTH MAINE MEDICAL CENTER
Subdivision Name
MMP Urology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200009AN
Medicare Provider Number
200009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/13/2013
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
MaineHealth
Chris Coon, Southern Region Vice President, Finance
(207) 662-6213
Primary Contact
MaineHealth
BRIAN MARDEN, Chief Pharmacy Officer
(207) 661-3057
Addresses
Street Address
100 Brickhill Ave. Suite 100
South Portland, ME 04106
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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