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NORTHWEST HOSPITAL CENTER
DSH210012 SINAI HOSPITAL OF BALTIMORE
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Covered Entity Details
Entity Name
SINAI HOSPITAL OF BALTIMORE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210012
Entity Address
2401 WEST BELVEDERE AVENUE
BALTIMORE, MD 21215
Medicare Provider Number
210012
Participating Start Date
7/1/2003
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
NORTHWEST HOSPITAL CENTER
Pharmacy Address
5401 OLD COURT RD
RANDALLSTOWN, MD 21133
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
NEIL MELTZER, PRESIDENT/CEO
(410) 601-5134
Contract Pharmacy Representative
Northwest Hospital Center
Rose Jose, Chief Operating Officer of Outpatient Pharmacy Services
(410) 701-4531
Signed By Date
4/15/2015
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