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DSH200033AZ EASTERN MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
EMMC PELVIC CARE AND CONTINENCE SPECIALISTS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200033AZ
Medicare Provider Number
200033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/22/2017
Last Recertification Date
9/2/2023
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
Eastern Maine Medical Center
Randy Brian Albert, VP Finance
(207) 973-4279
Primary Contact
Eastern Maine Medical Center
Lynn Thornton, Director of Pharmacy
(207) 973-9012
Addresses
Street Address
417 STATE STREET
SUITE 200
BANGOR, ME 04401
Billing Address
Eastern Maine Medical Center
489 STATE STREET
BANGOR, ME 04401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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