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CORAM HEALTHCARE CORPORATION OF GREATER
SCH210028-00 ST. MARYS HOSPITAL
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Covered Entity Details
Entity Name
ST. MARYS HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH210028-00
Entity Address
25500 POINT LOOKOUT RD
LEONARDTOWN, MD 20650
Medicare Provider Number
210028
Participating Start Date
10/1/2018
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CORAM HEALTHCARE CORPORATION OF GREATER
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
7150 COLUMBIA GATEWAY DRIVE
SUITE E
COLUMBIA, MD 21046
Pharmacy Comments
Contract Details
Approval Date
9/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carrie J Jennison, Chief Financial Officer
(301) 475-6003
Contract Pharmacy Representative
Coram
Tamalia Lloyd, Branch Manager
(800) 227-3675
Signed By Date
9/7/2018
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