340B Drug Pricing Program Database
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DSH200008AQ MERCY HOSPITAL (Active)
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Main Details
Name
MERCY HOSPITAL
Subdivision Name
Northern Light Mercy Primary Care, Windham
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200008AQ
Medicare Provider Number
200008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/17/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/27/2022
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Mercy Hospital
David Kennedy, VP of Finance
(207) 879-3363
Primary Contact
Northern Light Health
Amy Gamble, Director - 340B Program
(978) 549-5617
Addresses
Street Address
409 Roosevelt Trail
Windham, ME 04062
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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