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DSH210038 MARYLAND GENERAL HOSPITAL (Active)
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Main Details
Name
MARYLAND GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210038
Medicare Provider Number
210038
Additional Details
Current Program Status
Active
Registration Date
1/14/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/3/2016
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
University of Maryland Medical Center
Joseph Dicubellis, Senior Director of Pharmacy
(410) 328-6746
Primary Contact
UMMC Midtown Campus
Ifeanyi Egbunike, Director of Pharmacy
(410) 225-8009
Addresses
Street Address
827 LINDEN AVENUE
BALTIMORE, MD 21201
Billing Address
University of Maryland Medical System - Accounts Payable
PO Box 6545
Portland, OR 97228-6545
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated 4/1/2003 until terminated 7/1/2014, reinstated effective April 2016.
03/03/2016
April 2025
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