340B Drug Pricing Program Database
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DSH210038C MARYLAND GENERAL HOSPITAL (Active)
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Main Details
Name
MARYLAND GENERAL HOSPITAL
Subdivision Name
MTC PEDS OP CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210038C
Medicare Provider Number
210038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/9/2016
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 Ave
1st Floor
Suite A
BALTIMORE, MD 21201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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