340B Drug Pricing Program Database
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DSH210003C PRINCE GEORGES HOSPITAL (Terminated)
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Main Details
Name
PRINCE GEORGES HOSPITAL
Subdivision Name
Orthopedic Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210003C
Medicare Provider Number
210003
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/6/2015
Last Recertification Date
8/16/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
UM Capital Region Health System
Min Godwin, Chief Operating Officer
(212) 767-9602
Primary Contact
Prince Georges Hospital Center
DEE BUTLER, Corporate Director, Pharmacy Services Dimension Healthcare System
(301) 497-8773
Addresses
Street Address
3001 Hospital Drive
Cheverly, MD 20785
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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