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DSH200063T PENOBSCOT BAY MEDICAL CENTER (Terminated)
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Main Details
Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
Pen Bay Physical Therapy - Waldoboro
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200063T
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
8/19/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
Coastal Healthcare Alliance
Heather Shanklin, Chief Financial Officer
(207) 505-4131
Primary Contact
Maine Health
Minh Hoang, Director of 340B and Drug Supply Management
(207) 662-8064
Addresses
Street Address
40 Washington Street
Waldoboro, ME 04572
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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