Covered Entity Details

DSH210012Q SINAI HOSPITAL OF BALTIMORE (Active) - information as of 5/11/2025 11:38:57 PM

Main Details

Name

SINAI HOSPITAL OF BALTIMORE

Subdivision Name

Kreiger Eye Institute 6th Floor

Type

Disproportionate Share Hospital

Rural

340B ID

DSH210012Q

Medicare Provider Number

210012

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/13/2015

Participating Start Date

10/1/2015

Participating Approval Date

7/29/2015

Last Recertification Date

8/12/2024

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

2411 W. Belvedere Avenue
Baltimore, MD 21215

Billing Address

Sinai Hospital
2401 West Belvedere Avenue
Baltimore, MD 21215

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	000135000	1285672204
CO	64904512	1285672204
FL	096837400	1285672204
PA	0010584440008	1285672204

Shipping Addresses

Shipping Address 1

Sinai Hospital
2401 West Belvedere Avenue
Baltimore, MD 21215

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
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 9:08:27 AM	8/12/2024 9:04:49 AM	8/12/2024 9:04 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 10:39:26 AM	8/21/2023 9:08:27 AM	8/21/2023 9:08 AM
Details	Last Recertification Date	Update	Recertification	8/26/2021 1:12:16 PM	9/1/2022 10:39:26 AM	9/1/2022 10:39 AM
Addresses	Billing Address	Insert	Change Request		Sinai Hospital 2401 West Belvedere Avenue Baltimore, MD 21215	4/5/2022 7:30 AM
Addresses	Shipping Address	Insert	Change Request		Sinai Hospital 2401 West Belvedere Avenue Baltimore, MD 21215	4/5/2022 7:30 AM
Details	Last Recertification Date	Update	Recertification	8/19/2020 1:04:52 PM	8/26/2021 1:12:16 PM	8/26/2021 1:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285672204	8/19/2020 1:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/19/2020 1:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285672204	8/19/2020 1:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/19/2020 1:04 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1285672204	8/19/2020 1:04 PM
Medicaid Billing	NPI: State	Insert	Recertification		CO	8/19/2020 1:04 PM
Medicaid Billing	NPI: State	Update	Recertification		MD	8/19/2020 1:04 PM
Details	Last Recertification Date	Update	Recertification	8/27/2019 3:07:24 PM	8/19/2020 1:04:52 PM	8/19/2020 1:04 PM
Details	Last Recertification Date	Update	Recertification	8/23/2018 10:13:39 AM	8/27/2019 3:07:24 PM	8/27/2019 3:07 PM
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
Contacts	Signed By	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	11/27/2017 1:25:22 PM	8/23/2018 10:13:39 AM	8/23/2018 10:13 AM
Details	Entity Name	Update	Recertification	SINAI HOSPITAL OF BALTIMORE INC.	SINAI HOSPITAL OF BALTIMORE	11/29/2017 3:37 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	11/27/2017 1:25:22 PM	11/27/2017 1:25 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	Signed By	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	Signed By	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			2411 W. Belvedere Avenue Baltimore, MD 21215	11/16/2016 2:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: Number	Insert			64904512	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: State	Insert			CO	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: Number	Insert			096837400	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: State	Insert			FL	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: Number	Insert			0010584440008	8/23/2016 2:03 PM
Medicaid Billing	Medicaid: State	Insert			PA	8/23/2016 2:03 PM
Details	Last Recertification Date	Update			8/23/2016 12:00:00 AM	8/23/2016 2:03 PM
Details	Entity Subname	Update		KEI 6th Floor	Kreiger Eye Institute 6th Floor	7/29/2015 2:36 PM
Dates	Participating Approval Date	Update			7/29/2015 12:00:00 AM	7/29/2015 2:36 PM
Details	State	Update		Pending	Active	7/29/2015 2:36 PM
Dates	Start Date	Update			10/1/2015 12:00:00 AM	7/29/2015 2:36 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_53353	DSH210012Q	7/28/2015 5:29 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_53353	7/13/2015 2:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/13/2015 2:04 PM
Medicaid Billing	Medicaid: Number	Insert			000135000	7/13/2015 2:04 PM
Medicaid Billing	Medicaid: State	Insert			MD	7/13/2015 2:04 PM
Medicaid Billing	NPI: Number	Insert			1285672204	7/13/2015 2:04 PM
Details	Last Recertification Date	Insert				7/13/2015 2:04 PM
Details	Grant Number	Insert				7/13/2015 2:04 PM
Details	340B ID	Insert				7/13/2015 2:04 PM
Details	Is Authorizing Official EHB Data	Insert				7/13/2015 2:04 PM
Dates	Last Date That 340B Drugs Purchased	Insert				7/13/2015 2:04 PM
Details	Medicare Provider Number	Insert			210012	7/13/2015 2:04 PM
Details	Entity Name	Insert			SINAI HOSPITAL OF BALTIMORE INC.	7/13/2015 2:04 PM
Details	Program Code	Insert			DSH	7/13/2015 2:04 PM
Details	Entity Subname	Insert			KEI 6th Floor	7/13/2015 2:04 PM
Dates	Participating Approval Date	Insert				7/13/2015 2:04 PM
Details	State	Insert			Pending	7/13/2015 2:04 PM
Dates	Registration Date	Insert			7/13/2015 12:00:00 AM	7/13/2015 2:04 PM
Dates	Signed By Date	Insert			7/13/2015 12:00:00 AM	7/13/2015 2:04 PM
Dates	Start Date	Insert				7/13/2015 2:04 PM
Terminations	Termination Comments	Insert				7/13/2015 2:04 PM
Terminations	Termination Date	Insert				7/13/2015 2:04 PM
Terminations	Termination Effective Date	Insert				7/13/2015 2:04 PM
Terminations	Termination Reason	Insert				7/13/2015 2:04 PM