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MEDSTAR PHARMACY STORE #5
DSH090011 MEDSTAR WASHINGTON HOSPITAL CENTER
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Covered Entity Details
Entity Name
MEDSTAR WASHINGTON HOSPITAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH090011
Entity Address
110 IRVING STREET, NW
WASHINGTON, DC 20010
Medicare Provider Number
090011
Participating Start Date
1/1/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MEDSTAR PHARMACY STORE #5
Pharmacy Address
106 IRVING ST NW STE 1200
WASHINGTON, DC 20010-2952
Pharmacy Comments
06/13/2013 - Pharmacy name and address changed in error on 3/28/2013. 03/16/2012 changed name (was ENSIGN PHARMACIES INC)
Contract Details
Approval Date
1/1/2005
Contract Begin Date
1/1/2005
Carve-In Effective Date
Contract Comments
8/23/07 340B ID # CHANGED (WAS DSH20010)
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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