340B Drug Pricing Program Database
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DSH200009K MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
MAINE MEDICAL CENTER
Subdivision Name
FALMOUTH CAMPUS - AMBULATORY CLINIC SERVICES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200009K
Medicare Provider Number
200009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/26/2015
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Maine Medical Center
Lugene Anthony Inzana, CFO
(207) 662-2654
Primary Contact
Maine Health
Roya Tran, Director of 340B Program & Drug Supply Management
(207) 661-0304
Addresses
Street Address
5 BUCKMAN ROAD
FALMOUTH, ME 04105
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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