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SCH200052-00 NORTHERN MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
NORTHERN MAINE MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH200052-00
Medicare Provider Number
200052
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
9/14/2022
Termination Date
Termination Reason
4/1/2023
Change of covered entity type
Contacts
Authorizing Official
Northern Maine Medical Center
Alain Bois, Chief Operating Officer
(207) 834-1411
Primary Contact
Northern Maine Medical Center
Jordan Albert, Director of Pharmacy
(207) 834-1632
Addresses
Street Address
194 EAST MAIN ST
FORT KENT, ME 04743
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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