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CH01458C PENOBSCOT COMMUNITY HEALTH CENTER, INC. (Active)
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Main Details
Name
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
Subdivision Name
PENOBSCOT COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-003873
340B ID
CH01458C
Grant Number
H80CS04291
Additional Details
Current Program Status
Active
Registration Date
1/1/2002
Participating Start Date
1/1/2002
Participating Approval Date
12/6/2004
Last Recertification Date
3/6/2025
Contacts
Authorizing Official
Penobscot Community Health Center Inc.
Lorelle Dwyer, President & CEO
(207) 992-9200
Primary Contact
Penobscot Community Health Care
Meagan Rusby, Associate Director of Pharmacy
(207) 992-9200 Ext: 1764
Addresses
Street Address
1012 UNION STREET
BANGOR, ME 04401
Billing Address
PENOBSCOT COMMUNITY HEALTH CENTER, INC.
103 Maine Ave
BANGOR, ME 04401-2100
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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12/1/06 ADDED MEDICAID #; 12/6/04 ADMIN CORRECTION REPLACES FQHCLA114
01/21/2010
April 2025
April 2025
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