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CYSTIC FIBROSIS SERVICES, LLC
DSH210012 SINAI HOSPITAL OF BALTIMORE
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Covered Entity Details
Entity Name
SINAI HOSPITAL OF BALTIMORE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210012
Entity Address
2401 WEST BELVEDERE AVENUE
BALTIMORE, MD 21215
Medicare Provider Number
210012
Participating Start Date
7/1/2003
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
1/18/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NEIL MELTZER, PRESIDENT/CEO
(410) 601-5134
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2019
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