340B Drug Pricing Program Database
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DSH200008 MERCY HOSPITAL (Active)
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Main Details
Name
MERCY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200008
Medicare Provider Number
200008
Additional Details
Current Program Status
Active
Registration Date
1/17/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/27/2022
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Mercy Hospital
David Kennedy, VP of Finance
(207) 879-3363
Primary Contact
Northern Light Health
Amy Gamble, Director - 340B Program
(978) 549-5617
Addresses
Street Address
175 Fore River Parkway
PORTLAND, ME 04102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2013, terminated 7/1/2014. Reinstated 4/1/2022.
01/27/2022
April 2025
April 2025
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