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CAH201312-16 WALDO COUNTY GENERAL HOSPITAL (Terminated)
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Main Details
Name
WALDO COUNTY GENERAL HOSPITAL
Subdivision Name
WCMP Dermatology Associates
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH201312-16
Medicare Provider Number
201312
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/8/2017
Last Recertification Date
8/19/2021
Termination Date
Termination Reason
10/1/2022
Site closure
Contacts
Authorizing Official
Coastal Healthcare Alliance
Heather Shanklin, Chief Financial Officer
(207) 505-4131
Primary Contact
Maine Health
Minh Hoang, Director of 340B and Drug Supply Management
(207) 662-8064
Addresses
Street Address
16 Fahy St, Suite 202
Cobb Medical Building, First Floor
Belfast, ME 04915
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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