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MAINEHEALTH
DSH200063 PENOBSCOT BAY MEDICAL CENTER
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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 SPECIALTY AND HOME
340 COUNTY RD
WESTBROOK, ME 04092
Pharmacy Comments
Contract Details
Approval Date
7/8/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Heather Shanklin, Chief Financial Officer
(207) 505-4131
Contract Pharmacy Representative
MaineHealth
Andrea Lai, Senior Director of Ambulatory Pharmacy
(207) 662-5366
Signed By Date
7/8/2022
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