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DSH200033Y EASTERN MAINE MEDICAL CENTER (Active)
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Main Details
Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
EMMC PEDIATRIC SPECIALTY CARE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200033Y
Medicare Provider Number
200033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/29/2014
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Eastern Maine Medical Center
Randy Brian Albert, VP Finance
(207) 973-4279
Primary Contact
Eastern Maine Medical Center
Lynn Thornton, Director of Pharmacy
(207) 973-9012
Addresses
Street Address
133 Corporate Drive
BANGOR, ME 04401
Billing Address
Eastern Maine Medical Center
489 STATE STREET
Bangor, ME 04401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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