340B Drug Pricing Program Database
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CAH201301-05 CHARLES A. DEAN MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
CHARLES A. DEAN MEMORIAL HOSPITAL
Subdivision Name
Geriatric Services
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH201301-05
Medicare Provider Number
201301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/19/2016
Last Recertification Date
8/28/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
CA Dean
JENNIFER GOODRICH, CFO
(207) 695-5209
Primary Contact
Northern Light CA Dean and Mayo Hospitals
Deidre Gilbert, Regional Director of Pharmacy
(207) 695-5270
Addresses
Street Address
364 Pritham Ave.
Greenville, ME 04441
Billing Address
Charles A. Dean Memorial Hospital
43 Whiting Hill Rd.
Brewer, ME 04412
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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