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HM040741 Maine Medical Center (Terminated)
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Main Details
Name
Maine Medical Center
Subdivision Name
Maine Medical Center Out Patient Care
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM040741
Grant Number
H30MC24048
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/24/2019
Last Recertification Date
2/23/2022
Termination Date
Termination Reason
4/1/2023
Other
Contacts
Authorizing Official
Maine Medical Center
Lugene Anthony Inzana, CFO
(207) 662-2654
Primary Contact
MMC/Maine Hemophilia and Thrombosis Center
GLEN ROY, NURSE COORDINATOR
(207) 396-7683
Addresses
Street Address
100 Campus Drive
suite 121
Scarborough, ME 04074
Billing Address
Maine Medical Center
22 Bramhall St.
Portland, ME 04074
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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