340B Drug Pricing Program Database
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DSH200009CL MAINE MEDICAL CENTER (Terminated)
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Main Details
Name
MAINE MEDICAL CENTER
Subdivision Name
Medical Oncology Biddeford - Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200009CL
Medicare Provider Number
200009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/11/2020
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Maine Medical Center
Lugene Anthony Inzana, CFO
(207) 662-2654
Primary Contact
Maine Health
Roya Tran, Director of 340B Program & Drug Supply Management
(207) 661-0304
Addresses
Street Address
26 West Cole Rd
Suite 102
Biddefod, ME 04005
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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