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DSH210028 ST. MARYS HOSPITAL (Terminated)
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Main Details
Name
ST. MARYS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH210028
Medicare Provider Number
210028
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/28/2016
Last Recertification Date
11/15/2017
Termination Date
Termination Reason
8/27/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
MedStar St. Mary's Hospital & MedStar Southern Maryland Hospital Center
Carrie J Jennison, Chief Financial Officer
(301) 475-6003
Primary Contact
MedStar St. Mary's Hospital
Mary Ibegbu, Director of Pharmacy
(301) 475-6268
Addresses
Street Address
25500 POINT LOOKOUT RD
LEONARDTOWN, MD 20650
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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