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GIANT PHARMACY 108
DSH210024 UNION MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
UNION MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210024
Entity Address
201 E UNIVERSITY PARKWAY
BALTIMORE, MD 21218
Medicare Provider Number
210024
Participating Start Date
10/1/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
GIANT PHARMACY 108
Pharmacy Address
6340 YORK RD
BALTIMORE, MD 21212
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deana Stout, VP FINANCE
(410) 554-2228
Contract Pharmacy Representative
GIANT FOOD
KELLY SHANAHAN, DISTRICT PHARMACY MANAGER
(240) 461-2982
Signed By Date
4/11/2025
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