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DSH200033Z EASTERN MAINE MEDICAL CENTER (Active)
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Main Details
Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
EMMC PEDIATRIC Specialty Care (2nd location)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200033Z
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
417 State St
Suite 305
BANGOR, ME 04401
Billing Address
Eastern Maine Medical Center
489 State St
Bangor, ME 04401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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