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MAINEHEALTH
DSH200009 MAINEHEALTH MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
MAINEHEALTH MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200009
Entity Address
22 BRAMHALL STREET
PORTLAND, ME 04102
Medicare Provider Number
200009
Participating Start Date
7/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MAINEHEALTH
Pharmacy Address
MAINEHEALTH PHARMACY SPECIALTY AND HOME
340 COUNTY RD
WESTBROOK, ME 04092
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lugene Anthony Inzana, CFO
(207) 662-2654
Contract Pharmacy Representative
MaineHealth
Andrea Lai, Senior Director of Ambulatory Pharmacy
(207) 662-5366
Signed By Date
7/15/2022
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