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MEDSTAR SPECIALTY PHARMACY, LLC
DSH210034 HARBOR HOSPITAL INC.
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Covered Entity Details
Entity Name
HARBOR HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210034
Entity Address
3001 SOUTH HANOVER STREET
BALTIMORE, MD 21225
Medicare Provider Number
210034
Participating Start Date
10/1/2003
Last Recertification Date
8/16/2024
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
7/13/2020
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
Robert P. Lally Jr., CFO
(443) 777-7257
Contract Pharmacy Representative
MedStar Health
Bonnie Levin, AVP, Pharmacy Services
(410) 772-6773
Signed By Date
7/13/2020
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