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GIANT OF MARYLAND
DSH090004 Georgetown University Hospital
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Covered Entity Details
Entity Name
Georgetown University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH090004
Entity Address
3800 Reservoir Road, NW
Washington, DC 20007
Medicare Provider Number
090004
Participating Start Date
4/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
GIANT OF MARYLAND
Pharmacy Address
GIANT PHARMACY 132
10400 OLD GEORGETOWN ROAD
BETHESDA, MD 20814
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David C Ho, VP of Finance
(202) 444-4724
Contract Pharmacy Representative
GIANT FOOD
KELLY SHANAHAN, DISTRICT PHARMACY MANAGER
(240) 461-2982
Signed By Date
1/15/2025
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