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DSH210013 Grace Medical Center, Inc. (Terminated)
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Main Details
Name
Grace Medical Center, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210013
Medicare Provider Number
210013
Additional Details
Current Program Status
Terminated
Registration Date
5/19/2008
Participating Start Date
10/1/2002
Participating Approval Date
5/19/2008
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
4/1/2022
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
LifeBridge Health
Rebecca Altman, Vice President and Chief Integration Officer
(410) 601-9000
Primary Contact
Sinai Hospital
Lisa Polinsky, AVP, Pharmacy Services
(410) 601-4274
Addresses
Street Address
2000 WEST BALTIMORE STREET
BALTIMORE, MD 21223
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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