Contract Pharmacy Details

CORAM HEALTHCARE CORPORATION OF GREATER
DSH090011 MEDSTAR WASHINGTON HOSPITAL CENTER

Covered Entity Details

Entity Name

MEDSTAR WASHINGTON HOSPITAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH090011

Entity Address

110 IRVING STREET, NW
WASHINGTON, DC 20010

Medicare Provider Number

090011

Participating Start Date

1/1/2005

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

CORAM HEALTHCARE CORPORATION OF GREATER

Pharmacy Address

DBA CORAM CVS/SPECIALTY INFUSION SERVICE
4115 PLEASANT VALLEY DRIVE
SUITE 200
CHANTILLY, VA 20151

Pharmacy Comments

Contract Details

Approval Date

10/11/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Catherine Monge, Sr Vice President Operations
(202) 877-7454

Contract Pharmacy Representative

Coram Healthcare Corp of Greater DC
Brenda L Matthews, Branch Manager
(800) 227-3675

Signed By Date

10/11/2017

340B Drug Pricing Program Database