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DSH200039CD MAINEGENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
MAINEGENERAL MEDICAL CENTER
Subdivision Name
Pediatric Child Behavioral Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH200039CD
Medicare Provider Number
200039
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/29/2015
Last Recertification Date
11/20/2017
Termination Date
Termination Reason
4/1/2018
Site closure
Contacts
Authorizing Official
MaineGeneral Medical Center
Terrance Brann, Chief Financial Officer
(207) 623-6624
Primary Contact
MaineGeneral Medical Center
Jennifer A Kent, 340B Coordinator
(207) 248-5160
Addresses
Street Address
149 North St
Waterville, ME 04901
Billing Address
MaineGeneral Medical Center
Accounts Payable
35 Medical Center Parkway
Augusta, ME 04330
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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