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MEDSTAR SPECIALTY PHARMACY, LLC
DSH210062 MEDSTAR SOUTHERN MARYLAND HOSPITAL C
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Covered Entity Details
Entity Name
MEDSTAR SOUTHERN MARYLAND HOSPITAL C
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210062
Entity Address
7503 SURRATTS ROAD
CLINTON, MD 20735
Medicare Provider Number
210062
Participating Start Date
10/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MEDSTAR SPECIALTY PHARMACY, LLC
Pharmacy Address
7379 WASHINGTON BLVD
SUITE 101
ELKRIDGE, MD 21075-6358
Pharmacy Comments
Contract Details
Approval Date
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christine R Wray, President
(301) 877-4530
Contract Pharmacy Representative
MedStar Health
Bonnie Levin, AVP, Pharmacy Services
(410) 772-6773
Signed By Date
7/10/2020
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