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DSH200039AH MAINEGENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Otolaryngology - A
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200039AH
Medicare Provider Number
200039
Outpatient Facility Provider Number
200039
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/5/2014
Last Recertification Date
8/31/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
MaineGeneral Medical Center
Terrance Brann, Chief Financial Officer
(207) 623-6624
Primary Contact
MaineGeneral Medical Center
Andrea Gimpel-Blanchard, Director of Pharmacy
(207) 626-4133
Addresses
Street Address
12 Shuman Ave
Suite 6A
Augusta, ME 04330
Billing Address
MaineGeneral Medical Center
33 Stone Street
Augusta, ME 04330
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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