340B Drug Pricing Program Database
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DSH200063U PENOBSCOT BAY MEDICAL CENTER (Terminated)
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Main Details
Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
PT YMCA Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200063U
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
116 Union Street
Rockport, ME 04856
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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