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DSH210013A Grace Medical Center, Inc. (Terminated)
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Main Details
Name
Grace Medical Center, Inc.
Subdivision Name
St. Francis Outpatient Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210013A
Medicare Provider Number
210013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/25/2015
Last Recertification Date
9/8/2021
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
10 North Payson Street
Baltimore, MD 21223
Billing Address
Bon Secours Baltimore Health System
2000 West Baltimore
Baltimore, MD 21223
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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