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CORAM ALTERNATE SITE SERVICES, INC.
DSH090011 MEDSTAR WASHINGTON HOSPITAL CENTER
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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 ALTERNATE SITE SERVICES, INC.
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
6 SPRING MILL DR
MALVERN, PA 19355
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 Alternate Site Service Inc
Kerry Levy, Branch Manager
(610) 722-1600
Signed By Date
10/11/2017
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