340B Drug Pricing Program Database
GIANT PHARMACY 2304
DSH210062 MEDSTAR SOUTHERN MARYLAND HOSPITAL C - information as of 5/23/2025 10:58:46 PM
Covered Entity Details
Entity Name
MEDSTAR SOUTHERN MARYLAND HOSPITAL C
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210062
Entity Address
7503 SURRATTS ROAD
CLINTON, MD 20735
Medicare Provider Number
210062
Participating Start Date
10/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
GIANT PHARMACY 2304
Pharmacy Address
GIANT OF MARYLAND LLC
8905 BELAIR ROAD
NOTTINGHAM, MD 21236
Pharmacy Comments
Contract Details
Approval Date
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
purvi jani, CFO
(214) 991-6090
Contract Pharmacy Representative
GIANT FOOD
KELLY SHANAHAN, DISTRICT PHARMACY MANAGER
(240) 461-2982
Signed By Date
4/17/2025
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