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DSH210038F MARYLAND GENERAL HOSPITAL (Terminated)
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Main Details
Name
MARYLAND GENERAL HOSPITAL
Subdivision Name
MTC EYE CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210038F
Medicare Provider Number
210038
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/9/2016
Last Recertification Date
8/21/2018
Termination Date
Termination Reason
10/1/2019
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
University of Maryland Medical System
Craig Fleischmann, Vice President of Finance
(410) 328-1092
Primary Contact
UMMC Midtown Campus
Ifeanyi Egbunike, Director of Pharmacy
(410) 225-8009
Addresses
Street Address
300 ARMORY PL
BALTIMORE, MD 21201
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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