Covered Entity Details

DSH210012 SINAI HOSPITAL OF BALTIMORE (Active) - information as of 6/19/2025 11:45:59 PM

Main Details

Name

SINAI HOSPITAL OF BALTIMORE

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH210012

Medicare Provider Number

210012

Additional Details

Current Program Status

Active

Registration Date

3/3/2008

Participating Start Date

7/1/2003

Participating Approval Date

3/3/2008

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

LifeBridge Health
NEIL MELTZER, PRESIDENT/CEO
(410) 601-5134

Primary Contact

Sinai Hospital
Lisa Polinsky, AVP, Pharmacy Services
(410) 601-4274

Addresses

Street Address

2401 WEST BELVEDERE AVENUE
BALTIMORE, MD 21215

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
3/3/08-CORRECTED ADDRESS (WAS 2401 WEST BELVEDERE STREET)	03/03/2008

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MD	000135000	1285672204
CO	64904512	1285672204
FL	096837400	1285672204
PA	0010584440008	1285672204

Shipping Addresses

Shipping Address 1

The LifeBridge Pharmacy at Sinai Hospital
2401 W. Belvedere Ave
Baltimore, MD 21215

Shipping Address 2

SINAI HOSPITAL OF BALTIMORE
2401 WEST BELVEDERE AVENUE
Baltimore, MD 21215

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/11/2017	01/01/2018	08/31/2022	01/13/2023
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/11/2017	01/01/2018		10/11/2017
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/11/2017	01/01/2018	08/31/2022	01/13/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/11/2017	01/01/2018	08/31/2022	01/13/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/11/2017	01/01/2018	06/30/2023	04/08/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/11/2017	01/01/2018		10/11/2017
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	04/19/2018	07/01/2018	07/09/2021	04/12/2022
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	01/10/2024	04/01/2024		04/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	01/10/2024	04/01/2024		04/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	01/10/2024	04/01/2024		04/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/09/2024	10/01/2024		10/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	07/09/2024	10/01/2024		10/01/2024
Contract Detail	BRIOVARX OF MAINE INC	DBA BRIOVARX	53 DARLING AVE	SOUTH PORTLAND	ME	04106	01/17/2017	04/01/2017	10/01/2019	10/07/2019
Contract Detail	BRIOVARX OF MASSACHUSETTS, LLC	D/B/A BRIOVARX	BLDG 2 - UNIT A 145 BODWELL STREET	AVON	MA	02322	01/18/2017	04/01/2017	10/01/2019	10/07/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/15/2016	10/01/2016		11/16/2016
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/14/2021	08/19/2021		10/04/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/14/2021	08/19/2021		10/04/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/18/2019	04/01/2019		04/01/2019
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	07/14/2021	08/19/2021	04/13/2022	06/21/2022
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	01/10/2024	04/01/2024		04/01/2024
Contract Detail	EAGER PARK PHARMACY AND HEALTH SERVICES,	DBA WALGREENS #15284	900 N. WASHINGTON STREET SUITE 1	BALTIMORE	MD	21205	04/04/2025	07/01/2025		04/04/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/13/2020	10/01/2020	09/27/2023	04/08/2024
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/13/2020	10/01/2020	09/27/2023	04/08/2024
Contract Detail	FAIRVIEW SPECIALTY SERVICES PHARMACY	711 KASOTA AVENUE SE, SUITE A		MINNEAPOLIS	MN	55414	01/16/2015	04/01/2015	06/01/2017	06/01/2017
Contract Detail	GENOA HEALTHCARE LLC	975 N SOLOMONS ISLAND RD, STE 1A		PRINCE FREDERICK	MD	20678-3917	07/14/2021	08/19/2021		10/04/2021
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02216	1001 YORK ROAD	TOWSON	MD	21204	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04220	2311 HANOVER PIKE	HAMPSTEAD	MD	21074	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04017	28 MAGOTHY BEACH RD.	PASADENA	MD	21122	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10892	10201 REISTERSTOWN RD	OWINGS MILLS	MD	21117	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02066	4625 FALLS ROAD	BALTIMORE	MD	21209	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16430	11200 REISTERSTOWN RD	OWINGS MILLS	MD	21117	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16870	1737 REISTERSTOWN RD	PIKESVILLE	MD	21208	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04030	11623 REISTERSTOWN RD	REISTERSTOWN	MD	21136	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02043	3300A CENTENNIAL LANE	ELLICOTT CITY	MD	21042	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04411	5501 PARK HEIGHTS AVE	BALTIMORE	MD	21215	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04107	6828 REISTERSTOWN RD	BALTIMORE	MD	21215	01/06/2020	04/01/2020	05/12/2022	09/14/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04079	5603 BALTIMORE NATIONAL PIKE	BALTIMORE	MD	21228	01/06/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03976	2509-2523 PENNSYLVANIA AVE.	BALTIMORE	MD	21217	01/06/2020	04/01/2020		04/01/2020
Contract Detail	NATION'S HOME INFUSION LLC	11521 CRONRIDGE DRIVE	SUITE L-M	OWINGS MILLS	MD	21117	10/21/2014	01/01/2015	03/01/2023	03/07/2023
Contract Detail	NATION'S INFUSION AT HOME, LLC	NATION'S INFUSION AT HOME, LLC	11521 CRONRIDGE DR STE L	OWINGS MILLS	MD	21117	10/14/2024	01/01/2025		01/01/2025
Contract Detail	NORTHWEST HOSPITAL CENTER	5401 OLD COURT RD		RANDALLSTOWN	MD	21133	04/15/2015	07/01/2015	02/01/2019	02/01/2019
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	01/18/2017	04/01/2017	10/23/2020	11/13/2020
Contract Detail	OPTUM INFUSION SERVICES 103, LLC	9204 BERGER RD.	STE. A	COLUMBIA	MD	21046-1729	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM PHARMACY 700, LLC	5700 DOT COM CT, STE 1000		OVIEDO	FL	32765	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	07/14/2021	08/19/2021		10/04/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/12/2022	04/13/2022		04/19/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/17/2017	04/01/2017		01/17/2017
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	01/17/2017	04/01/2017		01/17/2017
Contract Detail	OPTUM PHARMACY 705, LLC	1893 GENERAL GEORGE PATTON DR	STE 106	FRANKLIN	TN	37067-2655	07/14/2021	08/19/2021		10/04/2021
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	01/18/2017	04/01/2017	08/31/2022	01/13/2023
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	10/09/2020	10/09/2020		11/02/2020
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/13/2020	07/01/2020		07/01/2020
Contract Detail	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	04/13/2020	07/01/2020	05/27/2022	01/13/2023
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/18/2019	04/01/2019	10/01/2022	11/08/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/15/2016	10/01/2016		11/16/2016
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/14/2021	08/19/2021		10/04/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/14/2021	08/19/2021		10/04/2021
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	01/10/2024	04/01/2024		04/01/2024
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	01/10/2024	04/01/2024		04/01/2024
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	01/10/2024	04/01/2024		04/01/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WAL-MART PHARMACY 10-1867	280 WOODWARD ROAD		WESTMINSTER	MD	21157	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WAL-MART PHARMACY 10-2279	6721 CHESAPEAKE CENTER DRIVE		GLEN BURNIE	MD	21060	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WAL-MART PHARMACY 10-2290	9750 REISTERTOWN ROAD		OWINGS MILLS	MD	21117	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WAL-MART PHARMACY 10-2436	6400A RIDGE ROAD SUITE 1		SYKESVILLE	MD	21784	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WAL-MART PHARMACY 10-2850	2320 NORTH HANOVER PIKE		HAMPSTEAD	MD	21074	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WAL-MART PHARMACY 10-3804	8730 LIBERTY ROAD		RANDALLSTOWN	MD	21133	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/16/2019	07/01/2019	09/18/2019	09/24/2019
Contract Detail	WALGREEN CO	DBA: WALGREENS #7678	1260 LIBERTY RD	ELDERSBURG	MD	21784-7928	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO	DBA: WALGREENS #11169	950 BEARDS HILL RD	ABERDEEN	MD	21001	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO	DBA: WALGREENS #10076	2560 QUARRY LAKE DR	BALTIMORE	MD	21209	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17587	6838 LOCH RAVEN BLVD	BALTIMORE	MD	21286	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17905	9150 BALTIMORE NATIONAL PIKE	ELLICOTT CITY	MD	21042	01/18/2019	04/01/2019	02/20/2024	04/08/2024
Contract Detail	WALGREEN CO.	WALGREENS #19380	6970 CRESTWOOD BLVD	FREDERICK	MD	21703	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19129	11917 REISTERSTOWN RD # 19	REISTERSTOWN	MD	21136-3030	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19401	711 W 40TH ST	BALTIMORE	MD	21211-2120	01/18/2019	04/01/2019	05/03/2023	06/27/2023
Contract Detail	WALGREEN CO.	WALGREENS #18951	2633 BRANDERMILL BLVD	GAMBRILLS	MD	21054	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17333	1000 KEY PKWY	FREDERICK	MD	21702-4056	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19212	23 W TIMONIUM RD	TIMONIUM	MD	21093	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19987	3446 OLNEY LAYTONSVILLE RD	OLNEY	MD	20832	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17889	3935 ERDMAN AVE # 37	BALTIMORE	MD	21213-2004	01/18/2019	04/01/2019	02/21/2023	03/07/2023
Contract Detail	WALGREEN CO.	WALGREENS #19144	2101 FALLSTON RD	FALLSTON	MD	21047-1425	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #16191	2411 W. BELVEDERE AVENUE SUITE 101	BALTIMORE	MD	21215	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #00392	122 CRANBROOK RD	COCKEYSVILLE	MD	21030	01/18/2019	04/01/2019	05/21/2019	07/10/2019
Contract Detail	WALGREEN CO.	WALGREENS #19115	140 BACK RIVER NECK RD	BALTIMORE	MD	21221-3924	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07573	6301 YORK ROAD	BALTIMORE	MD	21212-2636	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #03782	1712 CRAIN HWY S	GLEN BURNIE	MD	21061	01/18/2019	04/01/2019	06/03/2019	07/10/2019
Contract Detail	WALGREEN CO.	WALGREENS #17191	606 HOAGIE DR	BEL AIR	MD	21014	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17836	12224 TULLAMORE RD	TIMONIUM	MD	21093	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18082	6401 FREDERICK RD	CATONSVILLE	MD	21228	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #00354	2401 LIBERTY HEIGHTS AVE STE 2065	BALTIMORE	MD	21215	01/18/2019	04/01/2019	01/14/2019	07/10/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06779	9616 HARFORD ROAD	BALTIMORE	MD	21234-2104	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06265	9110 LIBERTY ROAD	RANDALLSTOWN	MD	21133	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #00368	1538 HAVENWOOD RD, SUITE 42	BALTIMORE	MD	21218	01/18/2019	04/01/2019	06/17/2019	07/10/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05623	3801 LIBERTY HEIGHTS AVE	BALTIMORE	MD	21215	01/18/2019	04/01/2019	01/23/2024	02/06/2025
Contract Detail	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15308	6 N HOWARD ST	BALTIMORE	MD	21201	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13840	8650 BELAIR RD.	NOTTINGHAM	MD	21236	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #00366	2497 FREDERICK AVE	BALTIMORE	MD	21223	01/18/2019	04/01/2019	05/20/2019	07/10/2019
Contract Detail	WALGREEN CO.	WALGREENS #17508	2926 BALTIMORE BLVD STE A	FINKSBURG	MD	21048	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07574	5657 BALTIMORE NATIONAL PIKE	CATONSVILLE	MD	21228-1412	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12790	6323 BALTIMORE NATIONAL PIKE	CATONSVILLE	MD	21228	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #16190	301 SAINT PAUL ST	BALTIMORE	MD	21202	01/18/2019	04/01/2019	02/18/2025	04/04/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05331	8050 LIBERTY ROAD	BALTIMORE	MD	21244	01/18/2019	04/01/2019	11/06/2023	11/28/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13457	500 MEADOW CREEK DRIVE	WESTMINSTER	MD	21158	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18946	300 PULASKI HWY	JOPPA	MD	21085-3614	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18015	4733 WESTLAND BLVD STE 21	ARBUTUS	MD	21227	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19086	7535 HOLABIRD AVE	BALTIMORE	MD	21222-2105	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17609	300 MARTIN LUTHER KING JR BLVD	BALTIMORE	MD	21201	01/18/2019	04/01/2019	11/16/2023	11/28/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12847	1801 YORK RD	LUTHERVILLE	MD	21093	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17619	1600 E CHURCHVILLE RD	BEL AIR	MD	21015	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18096	1321 RIVERSIDE PKWY STE 4	BELCAMP	MD	21017	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19924	7649 HARFORD RD	BALTIMORE	MD	21234	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #16196	750 MAIN STREET SUITE 104 E	REISTERSTOWN	MD	21136	01/18/2019	04/01/2019	03/30/2020	04/02/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02446	6 SOUTH MARLYN AVE	ESSEX	MD	21221	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #01792	5618 THE ALAMEDA	BALTIMORE	MD	21239	01/18/2019	04/01/2019	05/02/2019	07/10/2019
Contract Detail	WALGREEN CO.	WALGREENS #18308	2700 REMINGTON AVE STE 500	BALTIMORE	MD	21211-3043	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #00336	3133 GREENMOUNT AVENUE	BALTIMORE	MD	21218	01/18/2019	04/01/2019	02/10/2020	02/10/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12560	1510 REISTERSTOWN ROAD	PIKESVILLE	MD	21208	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17522	238 MCMECHEN ST	BALTIMORE	MD	21217	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11949	5585 TWIN KNOLLS RD	COLUMBIA	MD	21045	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05409	4020 EASTERN AVENUE	BALTIMORE	MD	21224	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19043	3463 SWEET AIR RD	PHOENIX	MD	21131	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18155	4214 FRANKFORD AVE	BALTIMORE	MD	21206-5131	01/18/2019	04/01/2019	01/22/2025	02/06/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15130	10410 YORK ROAD	COCKEYSVILLE	MD	21030	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19383	1132 ANNAPOLIS RD	ODENTON	MD	21113	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18160	3400 MOUNTAIN ROAD	PASADENA	MD	21122	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19843	8491 FORT SMALLWOOD RD	PASADENA	MD	21122	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS #16192	1838 GREENE TREE ROAD SUITE 100	PIKESVILLE	MD	21208	01/18/2019	04/01/2019	05/30/2024	07/09/2024
Contract Detail	WALGREEN CO.	WALGREENS #19427	403 GEORGE CLAUSS BLVD	SEVERN	MD	21144	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #19141	537 JERMOR LN	WESTMINSTER	MD	21157	01/18/2019	04/01/2019	11/13/2023	11/28/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #16186	6565 N. CHARLES STREET	BALTIMORE	MD	21204	01/18/2019	04/01/2019	11/15/2022	11/28/2022
Contract Detail	WALGREEN CO.	WALGREENS #19577	903 E FORT AVE	BALTIMORE	MD	21230	01/18/2019	04/01/2019	11/15/2022	11/28/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05638	4025 W NORTHERN PKWY	BALTIMORE	MD	21215	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17966	7270 MONTGOMERY RD	ELKRIDGE	MD	21075	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17917	12701 LAUREL BOWIE RD	LAUREL	MD	20708	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17201	415 E RIDGEVILLE BLVD	MOUNT AIRY	MD	21771	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07357	3005 EMMORTON ROAD	ABINGDON	MD	21009	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17205	1030 W 41ST ST STE E	BALTIMORE	MD	21211-1662	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #17300	29 SHIPPING PL # 31	BALTIMORE	MD	21222-4318	01/18/2019	04/01/2019	05/04/2023	06/27/2023
Contract Detail	WALGREEN CO.	WALGREENS #19149	6 CARROLL ISLAND RD	BALTIMORE	MD	21220	01/18/2019	04/01/2019	01/30/2025	02/06/2025
Contract Detail	WALGREEN CO.	WALGREENS #17610	1230 BAY DALE DR	ARNOLD	MD	21012	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 21331	2001 W PATAPSCO AVE	BALTIMORE	MD	21230	01/18/2019	04/01/2019	09/24/2020	09/24/2020
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06320	2204 N ROLLING ROAD	BALTIMORE	MD	21244	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	WALGREENS #18337	3700 FALLS RD	BALTIMORE	MD	21211	01/18/2019	04/01/2019	11/12/2024	02/06/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #16188	2000 W. BALTIMORE STREET	BALTIMORE	MD	21223	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREEN CO.	RITE AID #02217	35 EAST PADONIA ROAD	TIMONIUM	MD	21093	01/18/2019	04/01/2019	02/25/2019	07/10/2019
Contract Detail	WALGREEN CO.	WALGREENS #19374	6622 SECURITY BLVD # 24	BALTIMORE	MD	21207-4010	01/18/2019	04/01/2019	09/18/2023	10/03/2023
Contract Detail	WALGREEN CO.	RITE AID #03818	2203 DEFENSE HWY	CROFTON	MD	21114	01/18/2019	04/01/2019	09/30/2019	10/07/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 21331	2001 W PATAPSCO AVE	BALTIMORE	MD	21230	10/15/2020	01/01/2021	01/27/2025	02/06/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06396	8606 PHILADELPHIA RD	ROSEDALE	MD	21237	01/10/2022	04/01/2022		04/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05587	9621 BELAIR RD	BALTIMORE	MD	21236	01/10/2022	04/01/2022		04/01/2022
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12748	1201 E CHURCHVILLE RD	BEL AIR	MD	21014	01/10/2022	04/01/2022	03/27/2025	04/04/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05408	1300 EAST NORTH AVE	BALTIMORE	MD	21213-1406	01/10/2022	04/01/2022	11/13/2024	02/06/2025
Contract Detail	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21166	1114 CATHEDRAL ST. SUITE 3	BALTIMORE	MD	21201	04/04/2022	07/01/2022		07/01/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/18/2019	04/01/2019	10/01/2021	10/19/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/18/2019	04/01/2019		04/01/2019
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/18/2019	04/01/2019		04/01/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH210012A	Child	DSH	SINAI HOSPITAL OF BALTIMORE	SINAI HOSPITAL ADDICTIONS RECOVERY PROGRAM (SHARP)	AMBULATORY PSYCHIATRY BUILDING	BALTIMORE	MD	Active
DSH210012AA	Child	DSH	SINAI HOSPITAL OF BALTIMORE	FMF-Partial Day Program-Child - Behavioral Health	2000 W. Baltimore Street	Baltimore	MD	Active
DSH210012AB	Child	DSH	SINAI HOSPITAL OF BALTIMORE	FMF-Emergency Room - Emergency	2000 W. Baltimore Street	Baltimore	MD	Active
DSH210012B	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Neuro Psych	5051 Greenspring Avenue	Baltimore	MD	Active
DSH210012C	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Neurology	5051 Greenspring Avenue	Baltimore	MD	Active
DSH210012D	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Ambulatory Surgery Center	2435 West Belvedere Avenue, First Floor	Baltimore	MD	Active
DSH210012E	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Neurosurgery	5051 Greenspring Avenue	Baltimore	MD	Active
DSH210012F	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Adult Psych Partial Hospital Program	2440 Cylburn Avenue, 2nd Floor	Baltimore	MD	Terminated
DSH210012G	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Pharmacy Anticoagulation Clinic	2435 West Belvedere Avenue, Suite 11	Baltimore	MD	Active
DSH210012H	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Infectious Disease	2435 West Belvedere Avenue, Suite 17	Baltimore	MD	Active
DSH210012J	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Opthamology	2411 West Belvedere Avenue, Suite 505	Baltimore	MD	Active
DSH210012K	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Diabetes Program	2435 West Belvedere Avenue	Baltimore	MD	Active
DSH210012L	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Retina Clinic	2411 West Belvedere Avenue, Suite 502	Baltimore	MD	Active
DSH210012M	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Adult Oupatient Psych	2440 Cylburn Avenue, Second Floor	Baltimore	MD	Active
DSH210012N	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Sharp Mat Non-Grant	2440 Cylburn Avenue, Second Floor	Baltimore	MD	Active
DSH210012P	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Medicine Endocrinology	2435 West Belvedere Avenue, Suite 21	Baltimore	MD	Active
DSH210012Q	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Kreiger Eye Institute 6th Floor	2411 W. Belvedere Avenue	Baltimore	MD	Active
DSH210012R	Child	DSH	SINAI HOSPITAL OF BALTIMORE	MRI Mirowski	5051 Greenspring Ave Suite 107	Baltimore	MD	Active
DSH210012S	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Heart Failure Clinic	2435 W. Belvedere Ave Suite 52	Baltimore	MD	Active
DSH210012T	Child	DSH	SINAI HOSPITAL OF BALTIMORE	Morton Mower Clinic	2411 W. Belvedere Ave	Baltimore	MD	Terminated
DSH210012U	Child	DSH	SINAI HOSPITAL OF BALTIMORE	SINAI PEDIATRIC ENDOCRINOLOGY ASSOCIATES	2411 W BELVEDERE AVENUE SUITE 205	BALTIMORE	MD	Active
DSH210012V	Child	DSH	SINAI HOSPITAL OF BALTIMORE	SINAI GASTROENTEROLOGY	2411 W BELVEDERE AVENUE SUITE 305	BALTIMORE	MD	Active
DSH210012W	Child	DSH	SINAI HOSPITAL OF BALTIMORE	KAHLERT INFUSION CENTER CLINIC	291 Stoner Avenue	Westminster	MD	Active
DSH210012X	Child	DSH	SINAI HOSPITAL OF BALTIMORE	FMF - OP Behavioral Health - Behavioral Health	2000 W. Baltimore Street	Baltimore	MD	Active
DSH210012Y	Child	DSH	SINAI HOSPITAL OF BALTIMORE	FMF Observation Unit - Behavioral Health	2000 W. Baltimore Street	Baltimore	MD	Active
DSH210012Z	Child	DSH	SINAI HOSPITAL OF BALTIMORE	FMF-Partial Day Program - Behavioral Health	2000 W. Baltimore Street	Baltimore	MD	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/21/2023 8:48:41 AM	8/15/2024 9:15:00 AM	8/15/2024 9:15 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 8:14:02 PM	8/21/2023 8:48:41 AM	8/21/2023 8:48 AM
Details	Last Recertification Date	Update	Recertification	9/9/2021 9:57:31 PM	9/7/2022 8:14:02 PM	9/7/2022 8:14 PM
Details	Last Recertification Date	Update	Recertification	8/19/2020 3:09:08 PM	9/9/2021 9:57:31 PM	9/9/2021 9:57 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285672204	8/19/2020 3:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/19/2020 3:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285672204	8/19/2020 3:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/19/2020 3:09 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285672204	8/19/2020 3:09 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	8/19/2020 3:09 PM
Medicaid Billing	NPI: State	Update	Recertification		MD	8/19/2020 3:09 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 9:43:22 AM	8/19/2020 3:09:08 PM	8/19/2020 3:09 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 10:10:29 AM	8/28/2019 9:43:22 AM	8/28/2019 9:43 AM
Contacts	Authorizing Official	Update	Profile Change Request	MELTZER, NEIL PRESIDENT/COO Sinai 4106015133	MELTZER, NEIL PRESIDENT/CEO LifeBridge Health 4106015134	8/23/2018 10:19 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 3:37:57 PM	8/23/2018 10:10:29 AM	8/23/2018 10:10 AM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	11/29/2017 3:37:57 PM	11/29/2017 3:37 PM
Contacts	Primary Contact	Update	Profile Change Request	Polinsky, Lisa Director of Pharmacy Sinai Hospital 4106014274	Polinsky, Lisa AVP, Pharmacy Services Sinai Hospital 4106014274	11/3/2017 1:35 PM
Contacts	Authorizing Official	Update		MELTZER, NEIL PRESIDENT/COO 4106015133	MELTZER, NEIL PRESIDENT/COO Sinai 4106015133	10/11/2017 9:35 AM
Contacts	Primary Contact	Update		Polinsky, Lisa Director of Pharmacy 4106014274	Polinsky, Lisa Director of Pharmacy Sinai Hospital 4106014274	10/2/2017 1:46 PM
Contacts	Authorizing Official	Insert			MELTZER, NEIL PRESIDENT/COO 4106015133	6/1/2017 12:18 PM
Contacts	Primary Contact	Insert			Polinsky, Lisa Director of Pharmacy 4106014274	11/16/2016 2:52 PM
Addresses	Main Address	Insert			2401 WEST BELVEDERE AVENUE BALTIMORE, MD 21215	11/16/2016 2:52 PM
Addresses	Shipping Address	Insert			The LifeBridge Pharmacy at Sinai Hospital 2401 W. Belvedere Ave Baltimore, MD 21215	11/16/2016 2:52 PM
Addresses	Shipping Address	Insert			SINAI HOSPITAL OF BALTIMORE 2401 WEST BELVEDERE AVENUE Baltimore, MD 21215	11/16/2016 2:52 PM
Details	Last Recertification Date	Update		8/17/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/8/2016 12:23 PM
Medicaid Billing	Medicaid: Number	Insert			096837400	6/8/2016 12:23 PM
Medicaid Billing	Medicaid: State	Insert			FL	6/8/2016 12:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/8/2016 12:23 PM
Medicaid Billing	Medicaid: Number	Insert			0010584440008	6/8/2016 12:23 PM
Medicaid Billing	Medicaid: State	Insert			PA	6/8/2016 12:23 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	12/9/2015 10:51 AM
Medicaid Billing	Medicaid: Number	Insert			64904512	12/9/2015 10:51 AM
Medicaid Billing	Medicaid: State	Insert			CO	12/9/2015 10:51 AM
Details	Last Recertification Date	Update		8/19/2014 12:00:00 AM	8/17/2015 12:00:00 AM	8/17/2015 1:19 PM
Details	Last Recertification Date	Update		9/6/2013 12:00:00 AM	8/19/2014 12:00:00 AM	8/19/2014 11:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/6/2013 1:24 PM
Medicaid Billing	Medicaid: Number	Insert			000135000	9/6/2013 1:24 PM
Medicaid Billing	Medicaid: State	Insert			MD	9/6/2013 1:24 PM
Medicaid Billing	NPI: Number	Insert			1285672204	9/6/2013 1:24 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/6/2013 12:00:00 AM	9/6/2013 1:24 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/29/2012 12:21 PM
Dates	Participating Approval Date	Update		3/3/2008 4:39:33 PM	3/3/2008 12:00:00 AM	9/30/2011 3:34 PM
Details	Last Recertification Date	Insert				3/3/2008 4:42 PM
Details	Grant Number	Insert				3/3/2008 4:42 PM
Details	340B ID	Insert			DSH210012	3/3/2008 4:42 PM
Details	Is Authorizing Official EHB Data	Insert				3/3/2008 4:42 PM
Dates	Last Date That 340B Drugs Purchased	Insert				3/3/2008 4:42 PM
Details	Medicare Provider Number	Insert			210012	3/3/2008 4:42 PM
Details	Entity Name	Insert			SINAI HOSPITAL OF BALTIMORE	3/3/2008 4:42 PM
Details	Program Code	Insert			DSH	3/3/2008 4:42 PM
Details	Entity Subname	Insert				3/3/2008 4:42 PM
Dates	Participating Approval Date	Insert			3/3/2008 4:39:33 PM	3/3/2008 4:42 PM
Details	State	Insert			Active	3/3/2008 4:42 PM
Dates	Registration Date	Insert			3/3/2008 12:00:00 AM	3/3/2008 4:42 PM
Dates	Signed By Date	Insert				3/3/2008 4:42 PM
Dates	Start Date	Insert			7/1/2003 12:00:00 AM	3/3/2008 4:42 PM
Terminations	Termination Comments	Insert				3/3/2008 4:42 PM
Terminations	Termination Date	Insert				3/3/2008 4:42 PM
Terminations	Termination Effective Date	Insert				3/3/2008 4:42 PM
Terminations	Termination Reason	Insert				3/3/2008 4:42 PM
Details	Comments Public	Insert			3/3/08-CORRECTED ADDRESS (WAS 2401 WEST BELVEDERE STREET)	3/3/2008 4:42 PM