340B Drug Pricing Program Database
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DSH200063L PENOBSCOT BAY MEDICAL CENTER (Terminated)
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Main Details
Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
Pen Bay Speech and Hearing/Pediatric PT and OT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200063L
Medicare Provider Number
200063
Outpatient Facility Provider Number
200063
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/11/2013
Last Recertification Date
8/29/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Coastal Healthcare Alliance
Heather Shanklin, Chief Financial Officer
(207) 505-4131
Primary Contact
Coastal Health Alliance, MaineHealth
David MacMillan, Pharmacy Director
(207) 301-8563
Addresses
Street Address
15 Anchor Drive, Suite 104
Rockport, ME 04856
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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