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NEW ENGLAND LIFE CARE
DSH200033 EASTERN MAINE MEDICAL CENTER
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Covered Entity Details
Entity Name
EASTERN MAINE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH200033
Entity Address
489 STATE STREET
BANGOR, ME 04401
Medicare Provider Number
200033
Participating Start Date
10/1/2003
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
NEW ENGLAND LIFE CARE
Pharmacy Address
45 CENTER STREET SUITE A
SCARBOROUGH, ME 04074
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Raczek, COO, CMO, Senior VP
(207) 973-7026
Contract Pharmacy Representative
Paul Arpino, Regional Director of Pharmacy
(781) 932-4383
Signed By Date
1/15/2015
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