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AETNA SPECIALTY PHARMACY, LLC
DSH210009 JOHNS HOPKINS HOSPITAL
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Covered Entity Details
Entity Name
JOHNS HOPKINS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210009
Entity Address
600 NORTH WOLFE STREET
BALTIMORE, MD 21287
Medicare Provider Number
210009
Participating Start Date
7/1/2002
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
AETNA SPECIALTY PHARMACY, LLC
Pharmacy Address
503 SUNPORT LN
ORLANDO, FL 32809-7874
Pharmacy Comments
Contract Details
Approval Date
7/17/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/18/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel B. Smith, CFO
(443) 997-1312
Contract Pharmacy Representative
The Johns Hopkins Hospital
Shirley Geize, Assistant Director, Purchasing and Contracting for Pharmacy
(410) 955-0382
Signed By Date
7/17/2019
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