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DSH200009CM MAINEHEALTH MAINE MEDICAL CENTER (Active)
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Main Details
Name
MAINEHEALTH MAINE MEDICAL CENTER
Subdivision Name
MMP Dermatology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200009CM
Medicare Provider Number
200009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/11/2020
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
MaineHealth
Chris Coon, Southern Region Vice President, Finance
(207) 662-6213
Primary Contact
MaineHealth
BRIAN MARDEN, Chief Pharmacy Officer
(207) 661-3057
Addresses
Street Address
1601 Congress Street
Portland, ME 04102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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