Contract Pharmacy Details

MEDSTAR PHARMACY STORE # 12
DSH090011 MEDSTAR WASHINGTON HOSPITAL CENTER

Covered Entity Details

Entity Name

MEDSTAR WASHINGTON HOSPITAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH090011

Entity Address

110 IRVING STREET, NW
WASHINGTON, DC 20010

Medicare Provider Number

090011

Participating Start Date

1/1/2005

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

MEDSTAR PHARMACY STORE # 12

Pharmacy Address

9000 FRANKLIN SQUARE DR
ROSEDALE, MD 21237-3901

Pharmacy Comments

Contract Details

Approval Date

4/13/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/24/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Catherine Monge, Sr Vice President Operations
(202) 877-7454

Contract Pharmacy Representative

MedStar Health
Bonnie Levin, AVP, Pharmacy Services
(410) 772-6773

Signed By Date

4/13/2020

340B Drug Pricing Program Database