Covered Entity Details

DSH210037D MEMORIAL EASTON (Terminated) - information as of 5/6/2025 12:03:51 AM

Main Details

Name

MEMORIAL EASTON

Subdivision Name

University of Maryland Shore Medical Center at Cambridge - Emergency Services

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH210037D

Medicare Provider Number

210037

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/13/2022

Participating Start Date

10/1/2022

Participating Approval Date

9/14/2022

Last Recertification Date

9/6/2023

Termination Date
Termination Reason

1/1/2024
DSH percentage below statutory minimum

Contacts

Authorizing Official

University of Maryland Shore Regional Health
Kenneth Kozel, President and CEO
(410) 822-1000 Ext: 5500

Primary Contact

University of Maryland Shore Regional Health
Arvin Singh, Vice President
(410) 822-1000 Ext: 5508

Addresses

Street Address

715 Cambridge Marketplace Blvd
Cambridge, MD 21613

Billing Address

University of Maryland Shore Medical Center at Easton
219 S Washington Street
Easton, MD 21601

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	000305100	1669431219

Shipping Addresses

Shipping Address 1

University of Maryland Shore Medical Center at Easton
219 S Washington Street
Easton, MD 21601

Shipping Address 2

University of Maryland Shore Medical Center at Cambridge
715 Cambridge Marketplace Blvd
Cambridge, MD 21613

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
DSH210037A	Child	DSH	MEMORIAL EASTON	UM SHORE EMERGENCY CTR AT QUEENSTOW - Emergency Services	115 SHOREWAY DR	QUEENSTOWN	MD	Terminated
DSH210037B	Child	DSH	MEMORIAL EASTON	Cancer Center at UM Shore Regional Health - Cancer Services	509 Idlewild Avenue	Easton	MD	Terminated
DSH210037C	Child	DSH	MEMORIAL EASTON	University of Maryland Shore Pavilion at Cambridge: Infusion Clinic - Infusion Services	715 Cambridge Marketplace Blvd	Cambridge	MD	Terminated
DSH210037D	Child	DSH	MEMORIAL EASTON	University of Maryland Shore Medical Center at Cambridge - Emergency Services	715 Cambridge Marketplace Blvd	Cambridge	MD	Terminated
DSH210037E	Child	DSH	MEMORIAL EASTON	University of Maryland Shore Medical Center at Cambridge: CT - CT Services	715 Cambridge Marketplace Blvd	Cambridge	MD	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/30/2023 12:00:00 AM	12/1/2023 7:17 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/1/2023 7:17 AM
Terminations	Termination Date	Update	Termination Request		1/1/2024 12:00:00 AM	12/1/2023 7:17 AM
Terminations	Termination Effective Date	Update	Termination Request		11/30/2023 12:00:00 AM	12/1/2023 7:17 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/1/2023 7:17 AM
Details	Last Recertification Date	Update	Recertification		9/6/2023 3:52:12 PM	9/6/2023 3:52 PM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Kozel, Kenneth President and CEO University of Maryland Shore Regional Health 4108221000-5500	9/14/2022 8:35 AM
Details	340B ID	Update	New Registration		DSH210037D	9/14/2022 8:35 AM
Details	Entity Subname	Update	New Registration	University of Maryland Shore Medical Center at Cambridge	University of Maryland Shore Medical Center at Cambridge - Emergency Services	9/14/2022 8:35 AM
Dates	Participating Approval Date	Update	New Registration		9/14/2022 8:35:22 AM	9/14/2022 8:35 AM
Details	State	Update	New Registration	Pending	Approved	9/14/2022 8:35 AM
Dates	Signed By Date	Update	New Registration		7/13/2022 2:56:21 PM	9/14/2022 8:35 AM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	9/14/2022 8:35 AM
Addresses	Main Address	Insert	New Registration		715 Cambridge Marketplace Blvd Cambridge, MD 21613	7/13/2022 1:49 PM
Addresses	Billing Address	Insert	New Registration		University of Maryland Shore Medical Center at Easton 219 S Washington Street Easton, MD 21601	7/13/2022 1:49 PM
Addresses	Shipping Address	Insert	New Registration		University of Maryland Shore Medical Center at Easton 219 S Washington Street Easton, MD 21601	7/13/2022 1:49 PM
Addresses	Shipping Address	Insert	New Registration		University of Maryland Shore Medical Center at Cambridge 715 Cambridge Marketplace Blvd Cambridge, MD 21613	7/13/2022 1:49 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/13/2022 1:49 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		000305100	7/13/2022 1:49 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MD	7/13/2022 1:49 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1669431219	7/13/2022 1:49 PM
Medicaid Billing	NPI: State	Insert	New Registration		MD	7/13/2022 1:49 PM
Contacts	Authorizing Official	Insert	New Registration		Kozel, Kenneth President and CEO University of Maryland Shore Regional Health 4108221000-5500	7/13/2022 1:49 PM
Contacts	Primary Contact	Insert	New Registration		Singh, Arvin Vice President University of Maryland Shore Regional Health 4108221000-5508	7/13/2022 1:49 PM
Details	Assistance Received From Date	Insert	New Registration			7/13/2022 1:49 PM
Details	Assistance Received To Date	Insert	New Registration			7/13/2022 1:49 PM
Details	Last Recertification Date	Insert	New Registration			7/13/2022 1:49 PM
Details	Grant Number	Insert	New Registration			7/13/2022 1:49 PM
Details	340B ID	Insert	New Registration			7/13/2022 1:49 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/13/2022 1:49 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/13/2022 1:49 PM
Details	Medicare Provider Number	Insert	New Registration		210037	7/13/2022 1:49 PM
Details	Entity Name	Insert	New Registration		MEMORIAL EASTON	7/13/2022 1:49 PM
Details	NOFO Number	Insert	New Registration			7/13/2022 1:49 PM
Details	Program Code	Insert	New Registration		DSH	7/13/2022 1:49 PM
Details	Entity Subname	Insert	New Registration		University of Maryland Shore Medical Center at Cambridge	7/13/2022 1:49 PM
Dates	Participating Approval Date	Insert	New Registration			7/13/2022 1:49 PM
Details	State	Insert	New Registration		Pending	7/13/2022 1:49 PM
Dates	Registration Date	Insert	New Registration		7/13/2022 1:49:24 PM	7/13/2022 1:49 PM
Dates	Signed By Date	Insert	New Registration			7/13/2022 1:49 PM
Dates	Start Date	Insert	New Registration			7/13/2022 1:49 PM
Terminations	Termination Comments	Insert	New Registration			7/13/2022 1:49 PM
Terminations	Termination Date	Insert	New Registration			7/13/2022 1:49 PM
Terminations	Termination Effective Date	Insert	New Registration			7/13/2022 1:49 PM
Terminations	Termination Reason	Insert	New Registration			7/13/2022 1:49 PM