340B Drug Pricing Program Database
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DSH200009CD MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
MAINE MEDICAL CENTER
Subdivision Name
MMC Biddeford IV Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200009CD
Medicare Provider Number
200009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/20/2016
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
26 West Cole Road
Suite 101
Biddeford, ME 04005
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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