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EXPRESS SCRIPTS PHARMACY, INC.
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
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
2040 ROUTE 130 NORTH
BURLINGTON, NJ 08016
Pharmacy Comments
Contract Details
Approval Date
7/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
NEIL MELTZER, PRESIDENT/CEO
(410) 601-5134
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
7/13/2020
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