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DSH200009DE MAINEHEALTH MAINE MEDICAL CENTER (Active)
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Main Details
Name
MAINEHEALTH MAINE MEDICAL CENTER
Subdivision Name
Comprehensive Addiction Medicine - Portland - Comprehensive Addiction Medicine - Portland
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH200009DE
Medicare Provider Number
200009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/3/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/18/2024
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
576 St. John Street
Portland, ME 04102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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