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DSH200039BY MAINEGENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Obstetrics and Gynecology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200039BY
Medicare Provider Number
200039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/27/2015
Last Recertification Date
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
MaineGeneral Medical Center
Terrance Brann, Chief Financial Officer
(207) 623-6624
Primary Contact
MaineGeneral Medical Center
Terrance Brann, Chief Financial Officer
(207) 623-6624
Addresses
Street Address
Winthrop Commerce Center
16 Commerce Plaza, Suite 2D
Winthrop, ME 04364
Billing Address
MaineGeneral Medical Center
33 Stone Street
Augusta, ME 04330
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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