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DSH200024Q CENTRAL MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
CENTRAL MAINE MEDICAL CENTER
Subdivision Name
Lisbon Family Practice
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200024Q
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
9/12/2023
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
Central Maine Healthcare
Steve Littleson, Interim President & CEO
(207) 795-2947
Primary Contact
Central Maine Healthcare
Marcia Gooden, 340B Program Manager
(207) 795-2325
Addresses
Street Address
2 Bisbee Street
Lisbon, ME 04250
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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