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DSH200039M MAINEGENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
MaineGeneral Allergy & Asthma
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200039M
Medicare Provider Number
200039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/18/2013
Last Recertification Date
8/16/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
MaineGeneral Medical Center
Terrance Brann, Chief Financial Officer
(207) 623-6624
Primary Contact
MaineGeneral Medical Center
Andrea Gimpel-Blanchard, Director of Pharmacy
(207) 626-4133
Addresses
Street Address
12 Shuman Drive
Augusta, ME 04330
Billing Address
MaineGeneral Medical Center
Accounts Payable
35 Medical Center Parkway
Augusta, ME 04330
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/10/2014 - Multiple terminations/reinstatements recorded in error; site remained continuously eligible from participation start date.
04/14/2014
03/20/2014: Termination recorded in error; site remained continuously eligible from participation start date.
03/31/2014
April 2025
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