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DSH200024AE CENTRAL MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
CENTRAL MAINE MEDICAL CENTER
Subdivision Name
Central Maine Bariatric Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200024AE
Medicare Provider Number
200024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/25/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/26/2022
Last Recertification Date
Termination Date
Termination Reason
7/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Central Maine Healthcare
Steve Littleson, Interim President & CEO
(207) 795-2947
Primary Contact
Central Maine Healthcare
Martha Edwards Maunsell, Director of Reimbursement
(207) 795-2154
Addresses
Street Address
10 High Street
Suite 105
Lewiston, ME 04240
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (4/1/2014) until terminated effective date: (1/1/2016), reinstatement effective date: (4/1/2022)
01/26/2022
June 2025
June 2025
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