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GIANT PHARMACY #375
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
GIANT PHARMACY #375
Pharmacy Address
1050 BRENTWOOD RD NE
WASHINGTON, DC 20018
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
Amanda Lynn Barash, SVP & CFO
(202) 877-6147
Contract Pharmacy Representative
GIANT FOOD
KELLY SHANAHAN, DISTRICT PHARMACY MANAGER
(240) 461-2982
Signed By Date
1/15/2025
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