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DSH200009BF MAINEHEALTH MAINE MEDICAL CENTER (Active)
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Main Details
Name
MAINEHEALTH MAINE MEDICAL CENTER
Subdivision Name
Geriatrics Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200009BF
Medicare Provider Number
200009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/9/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/27/2015
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
MaineHealth
Chris Coon, Southern Region Vice President, Finance
(207) 662-6213
Primary Contact
MaineHealth
BRIAN MARDEN, Chief Pharmacy Officer
(207) 661-3057
Addresses
Street Address
66 Bramhall St
Portland, ME 04102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/27/15 previously participated starting on 4/1/2013, terminated 10/1/2013 due to voluntary withdrawal, reinstated based on registration submitted in April 2015
05/27/2015
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