Contract Pharmacy Details

UMMS PHARMACY SERVICES
DSH210037 MEMORIAL EASTON

Covered Entity Details

Entity Name

MEMORIAL EASTON

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210037

Entity Address

MEMORIAL HOSPITAL AT EASTON
219 SOUTH WASHINGTON STREET, MD 21601

Medicare Provider Number

210037

Participating Start Date

10/1/2022

Last Recertification Date

9/7/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

UMMS PHARMACY SERVICES

Pharmacy Address

UMMS PHARMACY SERVICES
920 ELKRIDGE LANDING ROAD
SUITE 1W111
LINTHICUM, MD 21090

Pharmacy Comments

Contract Details

Approval Date

8/9/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kenneth Kozel, President and CEO
(410) 822-1000 Ext: 5500

Contract Pharmacy Representative

University of Maryland Medical Center
Joseph Dicubellis, Senior Director of Pharmacy
(410) 328-6746

Signed By Date

7/15/2022

340B Drug Pricing Program Database