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DSH200063M PENOBSCOT BAY MEDICAL CENTER (Terminated)
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Main Details
Name
PENOBSCOT BAY MEDICAL CENTER
Subdivision Name
Pen Bay Specialty Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200063M
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
8/25/2019
Termination Date
Termination Reason
1/1/2020
Site closure
Contacts
Authorizing Official
Waldo County General Hospital
Linda Drinkwater, CFO
(207) 505-4104
Primary Contact
Waldo County General Hospital and Pen Bay Medical Center
Denise Needham, Regional Director of Pharmacy
(207) 921-8577
Addresses
Street Address
79 Schooner Street, Suite 1
Damariscotta, ME 04543
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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