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GIANT OF MARYLAND
SCH210028-00 ST. MARYS HOSPITAL
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Covered Entity Details
Entity Name
ST. MARYS HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH210028-00
Entity Address
25500 POINT LOOKOUT RD
LEONARDTOWN, MD 20650
Medicare Provider Number
210028
Participating Start Date
10/1/2018
Last Recertification Date
8/21/2024
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
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
purvi jani, CFO
(214) 991-6090
Contract Pharmacy Representative
GIANT FOOD
KELLY SHANAHAN, DISTRICT PHARMACY MANAGER
(240) 461-2982
Signed By Date
4/17/2025
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