Contract Pharmacy Details

MAINEHEALTH
DSH200063 PENOBSCOT BAY MEDICAL CENTER

Covered Entity Details

Entity Name

PENOBSCOT BAY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH200063

Entity Address

6 Glen Cove Dr
Rockport, ME 04856

Medicare Provider Number

200063

Participating Start Date

4/1/2006

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

MAINEHEALTH

Pharmacy Address

MAINEHEALTH PHARMACY MAINE MEDICAL CENTE
22 BRAMHALL ST
PORTLAND, ME 04102

Pharmacy Comments

Contract Details

Approval Date

4/7/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Linda Drinkwater, CFO
(207) 505-4104

Contract Pharmacy Representative

Maine Medical Center
Andrea Lai, Director of Ambulatory Care Pharmacy Services
(207) 662-5366

Signed By Date

4/7/2016

340B Drug Pricing Program Database