Date Granted - Maine

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|Date Approved Waiver List |Provider |Town/City |Waiver Reason |Expiration |

|7/29/2002 |Aroostook Medical Center |Presque Isle |Substantially equivalent - 3.B |N/A |

|8/14/2002 |Mercy Pain Center |Portland |Substantially equivalent - 3.B |N/A |

|9/23/2002 |Michele E. Spekhardt, D.M.D., P.A. |Bangor |Substantially equivalent - 3.E |N/A |

|10/8/2002 |Mercy Hospital - Emergency Room |Portland |Substantially equivalent - 3.E |N/A |

|10/21/2002 |Horizons Health Services |Fort Fairfield |Substantially equivalent - 3.B |N/A |

|11/7/2002 |Bangor Internal Medicine Associates |Bangor |Substantially equivalent - 3.E |N/A |

|11/25/2002 |Aroostook Family Practice |Presque Isle |Substantially equivalent - 3.E |N/A |

|12/2/2002 |Elm City Medical Associates, P.A. |Waterville |Substantially equivalent - 3.E |N/A |

|12/19/2002 |Daniel J. Bizier, D.M.D., P.A. |Lewiston |Substantially equivalent - 3.E |N/A |

|1/7/2003 |Orthopedic Associates of Portland, P.A. |Portland |Substantially equivalent - 3.B |N/A |

| | |Biddeford, Brunswick, Cumberland, |Substantially equivalent - 3.E |N/A |

|3/27/2003 |Bowdoin Medical Group |Gorham, Knightville and Portland | | |

|5/13/2003 |Eastern Maine Medical Center Family Practice |Bangor |Substantially equivalent - 3.E |N/A |

|2/23/2005 |Central Maine Clinical Associates |Lewiston |Substantially equivalent - 3.E |N/A |

|10/25/2005 |Midcoast Maine, P.A. |Rockland |Substantially equivalent - 3.E |N/A |

|11/3/2005 |Central Maine Medical Center Medical Oncology |Lewiston |Substantially equivalent - 3.E |N/A |

|11/3/2005 |Central Maine Medical Center Radiation Oncology |Lewiston |Substantially equivalent - 3.E |N/A |

|11/22/2005 |York Primary Care |York |Substantially equivalent - 3.E |N/A |

|11/6/2006 |Penobscot Nation Health Department |Indian Island |Substantially equivalent - 3.E |N/A |

|7/11/2006 |Waldoboro Family Medicine |Waldoboro |Substantially equivalent - 3.E |N/A |

|Date Granted |Provider |Town/City |Waiver Reason |Expiration |

|3/12/2008 |Medical Rehabilitation Associates |Lewiston |Substantially equivalent - 3.E |N/A |

|7/1/2008 |Family Medicine |Camden |Substantially equivalent - 3.E |N/A |

|8/14/2008 |Rx Security (Printer) |Port Chester, NY |Substantially equivalent - 3.E |N/A |

|10/30/2008 |Sebasticook Family Doctors |Newport |Substantially equivalent - 3.E |N/A |

|4/4/2008 |Pediatric Associates of Lewiston, PA |Lewiston |Substantially equivalent - 3.E |N/A |

|6/5/2008 |Cornerstone Behavioral Health |Waterville |Substantially equivalent - 3.E |N/A |

|6/18/2009 |Michael E. Trueworthy, CNP |Scarborough |Substantially equivalent - 3.E |N/A |

|4/10/2010 |Skowhegan Family Medicine |Skowhegan |Substantially equivalent - 3.E |N/A |

|6/6/2010 |Island Community Medical Services, Inc. |Vinalhaven |Substantially equivalent - 3.E |N/A |

|8/31/2010 |Saint Joseph Internal Medicine |Bangor |Substantially equivalent - 3.E |N/A |

|11/24/2011 |Waterville Pediatrics |Waterville |Substantially equivalent - 3.E | |

| | | | |N/A |

|1/27/2011 |Jean Burton, NP |Portland |Substantially equivalent - 3.E |N/A |

|3/11/2011 |Franklin Memorial Hospital |Farmington |Substantially equivalent - 3.E |N/A |

|07/22/11 |Sacoppee Valley Health Center |Porter |Substantially equivalent – 3.B & E |N/A |

|08/03/11 |Kittery Family Practice |Kittery |Substantially equivalent – 3.B |N/A |

|12/28/11 |InterMED – Yarmouth Health Center |Yarmouth |Substantially equivalent – 3.B |N/A |

|12/17/12 |Kennebec Behavioral Health |Waterville |Substantially equivalent – 3.B |N/A |

|04/30/13 |Central Maine Medical Center |Lewiston |Substantially equivalent – 3.B |N/A |

|04/30/13 |Rumford Hospital |Rumford |Substantially equivalent – 3.B |N/A |

|Date Granted |Provider |Town/City |Waiver Reason |Expiration |

|04/30/13 |Bridgton Hospital |Bridgton |Substantially equivalent – 3.B |N/A |

|06/19/13 |York Hospital |York, Wells, Kittery, Berwick |Substantially equivalent – 3.B |N/A |

|06/25/13 |Arthur Jewell Community Health Center |Brooks |Substantially equivalent – 3.B |N/A |

|10/31/13 |Northern Maine Medical Center |Fort Kent |Substantially equivalent – 3.B |N/A |

|11/08/13 |New England Rehabilitation Hospital |Portland |Substantially equivalent – 3.B |N/A |

|02/03/14 |Full Circle Health Care, LLC |Presque Isle |Substantially equivalent – 3.B |N/A |

|02/12/14 |MaineOrtho |Portland |Substantially equivalent – 3.B |N/A |

|10/24/14 |Millinocket Regional Hospital |Millinocket |Substantially equivalent – 3.B |N/A |

|10/30/14 |Falmouth Orthopedic Center |Falmouth |Substantially equivalent – 3.B |N/A |

|11/25/14 |Waterville Family Practice |Waterville |Substantially equivalent – 3.B |N/A |

|01/13/15 |Waterboro Village Pediatrics – Kati DeRevere |Mount Desert |Substantially equivalent – 3.B |N/A |

|02/04/15 |Mount Desert Island Hospital |Mount Desert |Substantially equivalent – 3.B |N/A |

|02/24/15 |Health Affiliates Maine |Auburn, Bangor, Mount Desert |Substantially equivalent – 3.B |N/A |

|03/02/15 |Maine General Psychiatry |Augusta |Substantially equivalent – 3.B |N/A |

|8/12/15 |Coastal Maine Psychiatry |Portland |Substantially equivalent – 3.B |N/A |

|9/1/15 |ClearChoiceMD |Scarborough |Substantially equivalent – 3.B |N/A |

|9/8/15 |Southern Maine Health Care – all providers |Biddeford, all locations |Substantially equivalent – 3.B |N/A |

|9/14/15 |Bucksport Regional Health Center – all providers |Bucksport |Substantially equivalent – 3.B |N/A |

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