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DSH200039S MAINEGENERAL MEDICAL CENTER (Active)
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Main Details
Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Four Seasons Family Practice
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200039S
Medicare Provider Number
200039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/18/2013
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
MaineGeneral Medical Center
Terrance Brann, Chief Financial Officer
(207) 623-6624
Primary Contact
MaineGeneral Medical Center
Jennifer A Kent, 340B Coordinator
(207) 248-5160
Addresses
Street Address
4 Sheridan Drive
Fairfield, ME 04937
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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