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MEDSTAR SPECIALTY PHARMACY, LLC
DSH210015 FRANKLIN SQUARE HOSPITAL
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Covered Entity Details
Entity Name
FRANKLIN SQUARE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210015
Entity Address
9000 FRANKLIN SQUARE DR
BALTIMORE, MD 21237
Medicare Provider Number
210015
Participating Start Date
4/1/2015
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
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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