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NEW ENGLAND LIFE CARE
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
NEW ENGLAND LIFE CARE
Pharmacy Address
45 CENTER STREET SUITE A
SCARBOROUGH, ME 04074
Pharmacy Comments
Contract Details
Approval Date
7/31/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/24/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lugene Anthony Inzana, CFO
(207) 662-2654
Contract Pharmacy Representative
Paul Arpino, Regional Director of Pharmacy
(781) 932-4383
Signed By Date
7/31/2014
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