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CH01458BJ PENOBSCOT COMMUNITY HEALTH CENTER (Active)
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Main Details
Name
PENOBSCOT COMMUNITY HEALTH CENTER
Subdivision Name
Maine Avenue Administration/Clinical Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-008838
340B ID
CH01458BJ
Grant Number
H80CS04291
Additional Details
Current Program Status
Active
Registration Date
10/3/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/7/2016
Last Recertification Date
3/6/2025
Contacts
Authorizing Official
Penobscot Community Health Center Inc.
Lorelle Dwyer, President & CEO
(207) 992-9200
Primary Contact
Penobscot Community Health Care
Meagan Rusby, Associate Director of Pharmacy
(207) 992-9200 Ext: 1764
Addresses
Street Address
103 Maine Ave
Bangor, ME 04401-4330
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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