340B Drug Pricing Program Database
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DSH210011 ST. AGNES HOSPITAL (Active)
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Main Details
Name
ST. AGNES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210011
Medicare Provider Number
210011
Additional Details
Current Program Status
Active
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/29/2016
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Saint Agnes Healthcare
Mitchell Gardner Lomax, CFO
(667) 234-2926
Primary Contact
Ascension Rx
Bridget Caito, 340b Program Manager
(248) 563-8931
Addresses
Street Address
900 CATON AVENUE
BALTIMORE, MD 21229
Billing Address
Ascension Ministry Service Center
Vendor Invoices, P.O. Box 33902
Indianapolis, IN 46203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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