Covered Entity Details

DSH210015A FRANKLIN SQUARE HOSPITAL (Active) - information as of 5/6/2025 12:02:41 AM

Main Details

Name

FRANKLIN SQUARE HOSPITAL

Subdivision Name

Ambulatory Oncology Clinic - Weinberg Center / Oncology Clinic

Type

Disproportionate Share Hospital

Rural

340B ID

DSH210015A

Medicare Provider Number

210015

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/15/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/6/2015

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Union Memorial Hospital
Deana Stout, VP FINANCE
(410) 554-2228

Primary Contact

MedStar Franklin Square and MedStar Harbor Hospital
Daisy Butrim, Multi-site 340B Program Manager
(443) 777-8429

Addresses

Street Address

9103 Franklin Square Drive
Suite 1400
Baltimore, MD 21237

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

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	000045100	1184712085
DC	020700500	1184712085

Shipping Addresses

Shipping Address 1

Franklin Square Hospital
9103 Franklin Square Drive
Baltimore, MD 21237

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH210015A	Child	DSH	FRANKLIN SQUARE HOSPITAL	Ambulatory Oncology Clinic - Weinberg Center / Oncology Clinic	9103 Franklin Square Drive	Baltimore	MD	Active
DSH210015B	Child	DSH	FRANKLIN SQUARE HOSPITAL	The Harry and Jeanette Weinberg Cancer Institute / Radiation Therapy Services/ Cyberknife	9103 Franklin Square Drive	Baltimore	MD	Active
DSH210015C	Child	DSH	FRANKLIN SQUARE HOSPITAL	Outpatient Psychiatric Clinic	9105 Franklin Square Drive	Baltimore	MD	Active
DSH210015D	Child	DSH	FRANKLIN SQUARE HOSPITAL	MedStar Franklin Square Hospital - MFS Cancer Med Onc@ Loch Raven	5601 Loch Raven Blvd	Baltimore	MD	Terminated
DSH210015E	Child	DSH	FRANKLIN SQUARE HOSPITAL	MedStar Franklin Square Hospital - MFS Cancer Infusion @ Loch Raven	5601 Loch Raven Blvd	Baltimore	MD	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/30/2023 3:43:27 PM	8/14/2024 9:46:37 AM	8/14/2024 9:46 AM
Contacts	Primary Contact	Update	Recertification	Ryan, Joshua Andrew Director of Pharmacy MFSMC 4437777535	Butrim, Daisy Multi-site 340B Program Manager MedStar Franklin Square and MedStar Harbor Hospital 4437778429	8/30/2023 3:43 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 3:20:40 PM	8/30/2023 3:43:27 PM	8/30/2023 3:43 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 9:59:58 AM	9/1/2022 3:20:40 PM	9/1/2022 3:20 PM
Contacts	Authorizing Official	Update	Change Request	Lally Jr., Robert P. CFO MedStar Health 4437777257	Stout, Deana VP FINANCE Union Memorial Hospital 4105542228	5/25/2022 7:33 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 9:37:41 AM	8/23/2021 9:59:58 AM	8/23/2021 9:59 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1184712085 ( )		9/9/2020 9:37 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1184712085	9/9/2020 9:37 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/9/2020 9:37 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1184712085	9/9/2020 9:37 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/9/2020 9:37 AM
Details	Last Recertification Date	Update	Recertification	9/6/2019 12:40:17 PM	9/9/2020 9:37:41 AM	9/9/2020 9:37 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 12:58:16 PM	9/6/2019 12:40:17 PM	9/6/2019 12:40 PM
Contacts	Primary Contact	Update	Recertification	West, Timothy W Interim Director of Pharmacy MedStar Franklin Square Medical Center 4437774983	Ryan, Joshua Andrew Director of Pharmacy MFSMC 4437777535	9/5/2018 12:58 PM
Details	Last Recertification Date	Update	Recertification	11/6/2017 4:20:21 PM	9/5/2018 12:58:16 PM	9/5/2018 12:58 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1932144672 ( )		1/4/2018 3:37 PM
Contacts	Primary Contact	Update	Change Request	Ford, Raneesha D. Director of Pharmacy MedStar Health 4437777535	West, Timothy W Interim Director of Pharmacy MedStar Franklin Square Medical Center 4437774983	1/4/2018 3:33 PM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/6/2017 4:20:21 PM	11/6/2017 4:20 PM
Contacts	Authorizing Official	Update	Change Request	Lally Jr., Robert P. CFO 4437777257	Lally Jr., Robert P. CFO MedStar Health 4437777257	9/28/2017 9:19 PM
Contacts	Signed By	Update	Change Request	Lally Jr., Robert P. CFO 4437777257	Lally Jr., Robert P. CFO MedStar Health 4437777257	9/28/2017 9:19 PM
Contacts	Primary Contact	Update		Ford, Raneesha D. Director of Pharmacy 4437777535	Ford, Raneesha D. Director of Pharmacy MedStar Health 4437777535	9/28/2017 8:01 PM
Contacts	Primary Contact	Insert			Ford, Raneesha D. Director of Pharmacy 4437777535	8/9/2017 3:55 PM
Contacts	Authorizing Official	Insert			Lally Jr., Robert P. CFO 4437777257	8/9/2017 3:55 PM
Contacts	Signed By	Insert			Lally Jr., Robert P. CFO 4437777257	8/9/2017 3:55 PM
Addresses	Main Address	Insert			9103 Franklin Square Drive Suite 1400 Baltimore, MD 21237	9/21/2016 4:29 PM
Addresses	Shipping Address	Insert			Franklin Square Hospital 9103 Franklin Square Drive Baltimore, MD 21237	9/21/2016 4:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/21/2016 4:29 PM
Medicaid Billing	Medicaid: Number	Insert			020700500	9/21/2016 4:29 PM
Medicaid Billing	Medicaid: State	Insert			DC	9/21/2016 4:29 PM
Details	Last Recertification Date	Update		8/27/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 3:36 PM
Medicaid Billing	NPI: Number	Insert			1932144672	2/11/2016 8:23 PM
Details	Last Recertification Date	Update			8/27/2015 12:00:00 AM	8/28/2015 2:01 PM
Dates	Participating Approval Date	Update			3/6/2015 12:00:00 AM	3/6/2015 3:02 PM
Details	State	Update		Pending	Active	3/6/2015 3:02 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/6/2015 3:02 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_49918	DSH210015A	1/16/2015 1:43 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_49918	1/15/2015 4:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/15/2015 4:35 PM
Medicaid Billing	Medicaid: Number	Insert			000045100	1/15/2015 4:35 PM
Medicaid Billing	Medicaid: State	Insert			MD	1/15/2015 4:35 PM
Medicaid Billing	NPI: Number	Insert			1184712085	1/15/2015 4:35 PM
Details	Last Recertification Date	Insert				1/15/2015 4:35 PM
Details	Grant Number	Insert				1/15/2015 4:35 PM
Details	340B ID	Insert				1/15/2015 4:35 PM
Details	Is Authorizing Official EHB Data	Insert				1/15/2015 4:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/15/2015 4:35 PM
Details	Medicare Provider Number	Insert			210015	1/15/2015 4:35 PM
Details	Entity Name	Insert			FRANKLIN SQUARE HOSPITAL	1/15/2015 4:35 PM
Details	Program Code	Insert			DSH	1/15/2015 4:35 PM
Details	Entity Subname	Insert			Ambulatory Oncology Clinic - Weinberg Center / Oncology Clinic	1/15/2015 4:35 PM
Dates	Participating Approval Date	Insert				1/15/2015 4:35 PM
Details	State	Insert			Pending	1/15/2015 4:35 PM
Dates	Registration Date	Insert			1/15/2015 12:00:00 AM	1/15/2015 4:35 PM
Dates	Signed By Date	Insert			1/15/2015 12:00:00 AM	1/15/2015 4:35 PM
Dates	Start Date	Insert				1/15/2015 4:35 PM
Terminations	Termination Comments	Insert				1/15/2015 4:35 PM
Terminations	Termination Date	Insert				1/15/2015 4:35 PM
Terminations	Termination Effective Date	Insert				1/15/2015 4:35 PM
Terminations	Termination Reason	Insert				1/15/2015 4:35 PM