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NATION'S HOME INFUSION LLC
DSH210040 NORTHWEST HOSPITAL CENTER, INC.
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Covered Entity Details
Entity Name
NORTHWEST HOSPITAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210040
Entity Address
5401 OLD COURT ROAD
RANDALLSTOWN, MD 21133
Medicare Provider Number
210040
Participating Start Date
10/1/2015
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
NATION'S HOME INFUSION LLC
Pharmacy Address
11521 CRONRIDGE DRIVE
SUITE L-M
OWINGS MILLS, MD 21117
Pharmacy Comments
Contract Details
Approval Date
7/28/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian White, President of Northwest Hospital
(410) 701-5995
Contract Pharmacy Representative
Sinai Hospital
Lisa Polinsky, AVP, Pharmacy Services
(410) 601-4274
Signed By Date
7/28/2015
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