Contract Pharmacy Details

MEDSTAR PHARMACY AT GSH
DSH210015 FRANKLIN SQUARE HOSPITAL

Covered Entity Details

Entity Name

FRANKLIN SQUARE HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210015

Entity Address

9000 FRANKLIN SQUARE DR
BALTIMORE, MD 21237

Medicare Provider Number

210015

Participating Start Date

4/1/2015

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

MEDSTAR PHARMACY AT GSH

Pharmacy Address

5601 LOCH RAVEN BLVD
BALTIMORE, MD 21239-2945

Pharmacy Comments

Contract Details

Approval Date

7/12/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Robert P. Lally Jr., CFO
(443) 777-7257

Contract Pharmacy Representative

MedStar Health
Bonnie Levin, AVP, Pharmacy Services
(410) 772-6773

Signed By Date

7/12/2017

340B Drug Pricing Program Database