Covered Entity Details

DSH210003N Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center (Active) - information as of 4/23/2025 10:51:49 PM

Main Details

Name

Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center

Subdivision Name

UM LAUREL MEDICAL CENTER - Lithotripsy

Type

Disproportionate Share Hospital

Rural

340B ID

DSH210003N

Medicare Provider Number

210003

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/14/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/3/2020

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

University of Maryland Capital Region Health
Michael Brozic, Chief Financial Officer
(410) 913-1546

Primary Contact

University of Maryland Capital Region Health
Lea Wade, 340B Analyst
(301) 237-4404

Addresses

Street Address

7150 Contee Road
Laurel, MD 20707

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	000345002	1720099286
DC	023573700401	1720099286

Shipping Addresses

Same as Street Address

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
DSH210003A	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	University of Maryland Bowie Health Center - EMG Emergency Services	15001 HEALTH CENTER DRIVE	BOWIE	MD	Active
DSH210003B	Child	DSH	PRINCE GEORGES HOSPITAL	Trauma Clinic	3001 Hospital Drive	Cheverly	MD	Terminated
DSH210003C	Child	DSH	PRINCE GEORGES HOSPITAL	Orthopedic Clinic	3001 Hospital Drive	Cheverly	MD	Terminated
DSH210003D	Child	DSH	PRINCE GEORGES HOSPITAL	Dietary Consults	3001 Hospital Drive	Cheverly	MD	Terminated
DSH210003E	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Radiology	7150 Contee Road	Laurel	MD	Active
DSH210003F	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Nuclear Medicine	7150 Contee Road	Laurel	MD	Active
DSH210003G	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Respiratory Therapy	7150 Contee Road	Laurel	MD	Active
DSH210003H	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Emergency Services	7150 Contee Road	Laurel	MD	Active
DSH210003J	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Anesthesiology	7150 Contee Road	Laurel	MD	Active
DSH210003K	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - CT SCAN	7150 Contee Road	Laurel	MD	Active
DSH210003L	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Hyperbaric Services	7400 Van Dusen	Laurel	MD	Active
DSH210003M	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Observation	7150 Contee Road	Laurel	MD	Active
DSH210003N	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Lithotripsy	7150 Contee Road	Laurel	MD	Active
DSH210003P	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Psych Clinic	7150 Contee Road	Laurel	MD	Active
DSH210003Q	Child	DSH	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	UM LAUREL MEDICAL CENTER - Operating Room	7150 Contee Road	Laurel	MD	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/25/2023 7:36:03 AM	8/28/2024 5:30:33 PM	8/28/2024 5:30 PM
Details	Last Recertification Date	Update	Recertification	9/1/2022 12:47:50 PM	8/25/2023 7:36:03 AM	8/25/2023 7:36 AM
Contacts	Authorizing Official	Update	AO Change Request	Godwin, Min Chief Operating Officer UM Capital Region Health System 2127679602	Brozic, Michael Chief Financial Officer University of Maryland Capital Region Health 4109131546	6/27/2023 2:22 PM
Addresses	Main Address	Update	Group Change Request	7300 VAN DUSEN RD LAUREL, MD 20707-9463	7150 Contee Road Laurel, MD 20707	6/8/2023 9:26 AM
Contacts	Primary Contact	Update	Recertification	Butler, Demetris VP Clinical Support Services Univ of Maryland Capital Region 2406064589	Wade, Lea 340B Analyst University of Maryland Capital Region Health 3012374404	9/1/2022 12:47 PM
Details	Last Recertification Date	Update	Recertification	9/10/2021 9:03:43 AM	9/1/2022 12:47:50 PM	9/1/2022 12:47 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	023573700417 (DC)		9/10/2021 9:03 AM
Contacts	Primary Contact	Update	Recertification	BUTLER, DEE Corporate Director, Pharmacy Services Dimension Healthcare System Prince Georges Hospital Center 3014978773	Butler, Demetris VP Clinical Support Services Univ of Maryland Capital Region 2406064589	9/10/2021 9:03 AM
Details	Last Recertification Date	Update	Recertification	9/10/2020 8:53:10 AM	9/10/2021 9:03:43 AM	9/10/2021 9:03 AM
Details	Entity Name	Update	Change Request	Dimensions Health Corporation d/b/a University of Maryland Prince Georges Hospital Center	Dimensions Health Corporation d/b/a University of Maryland Capital Region Medical Center	6/9/2021 2:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 2:22 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		023573700401	12/14/2020 2:22 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DC	12/14/2020 2:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/14/2020 2:22 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		023573700417	12/14/2020 2:22 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DC	12/14/2020 2:22 PM
Contacts	Authorizing Official	Update	Profile Change Request	Godwin, Min Interim COO UM Capital Region Health System 2127679602	Godwin, Min Chief Operating Officer UM Capital Region Health System 2127679602	9/10/2020 8:54 AM
Contacts	Signed By	Update	Profile Change Request	Godwin, Min Interim COO UM Capital Region Health System 2127679602	Godwin, Min Chief Operating Officer UM Capital Region Health System 2127679602	9/10/2020 8:54 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	023573700 (DC)		9/10/2020 8:53 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1720099286 (VA)		9/10/2020 8:53 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	000345000 (MD)		9/10/2020 8:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/10/2020 8:53 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		000345002	9/10/2020 8:53 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MD	9/10/2020 8:53 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1720099286 ( )		9/10/2020 8:53 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1720099286	9/10/2020 8:53 AM
Medicaid Billing	NPI: State	Insert	Recertification		DC	9/10/2020 8:53 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1720099286	9/10/2020 8:53 AM
Medicaid Billing	NPI: State	Insert	Recertification		MD	9/10/2020 8:53 AM
Details	Last Recertification Date	Update	Recertification		9/10/2020 8:53:10 AM	9/10/2020 8:53 AM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Godwin, Min Interim COO UM Capital Region Health System 2127679602	2/3/2020 9:28 AM
Details	340B ID	Update	New Registration		DSH210003N	2/3/2020 9:28 AM
Details	Entity Subname	Update	New Registration	UM LAUREL MEDICAL CENTER	UM LAUREL MEDICAL CENTER - Lithotripsy	2/3/2020 9:28 AM
Dates	Participating Approval Date	Update	New Registration		2/3/2020 9:28:45 AM	2/3/2020 9:28 AM
Details	State	Update	New Registration	Pending	Approved	2/3/2020 9:28 AM
Dates	Signed By Date	Update	New Registration		1/15/2020 12:35:04 PM	2/3/2020 9:28 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/3/2020 9:28 AM
Addresses	Main Address	Insert	New Registration		7300 VAN DUSEN RD LAUREL, MD 20707-9463	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		023573700	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		DC	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1720099286	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		VA	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000345000	1/14/2020 8:02 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	1/14/2020 8:02 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720099286	1/14/2020 8:02 PM
Contacts	Authorizing Official	Insert	New Registration		Godwin, Min Interim COO UM Capital Region Health System 2127679602	1/14/2020 8:02 PM
Contacts	Primary Contact	Insert	New Registration		BUTLER, DEE Corporate Director, Pharmacy Services Dimension Healthcare System Prince Georges Hospital Center 3014978773	1/14/2020 8:02 PM
Details	Last Recertification Date	Insert	New Registration			1/14/2020 8:02 PM
Details	Grant Number	Insert	New Registration			1/14/2020 8:02 PM
Details	340B ID	Insert	New Registration			1/14/2020 8:02 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/14/2020 8:02 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/14/2020 8:02 PM
Details	Medicare Provider Number	Insert	New Registration		210003	1/14/2020 8:02 PM
Details	Entity Name	Insert	New Registration		Dimensions Health Corporation d/b/a University of Maryland Prince Georges Hospital Center	1/14/2020 8:02 PM
Details	Program Code	Insert	New Registration		DSH	1/14/2020 8:02 PM
Details	Entity Subname	Insert	New Registration		UM LAUREL MEDICAL CENTER	1/14/2020 8:02 PM
Dates	Participating Approval Date	Insert	New Registration			1/14/2020 8:02 PM
Details	State	Insert	New Registration		Pending	1/14/2020 8:02 PM
Dates	Registration Date	Insert	New Registration		1/14/2020 8:02:18 PM	1/14/2020 8:02 PM
Dates	Signed By Date	Insert	New Registration			1/14/2020 8:02 PM
Dates	Start Date	Insert	New Registration			1/14/2020 8:02 PM
Terminations	Termination Comments	Insert	New Registration			1/14/2020 8:02 PM
Terminations	Termination Date	Insert	New Registration			1/14/2020 8:02 PM
Terminations	Termination Effective Date	Insert	New Registration			1/14/2020 8:02 PM
Terminations	Termination Reason	Insert	New Registration			1/14/2020 8:02 PM