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CORAM HEALTHCARE CORPORATION OF GREATER
DSH210028 ST. MARYS HOSPITAL
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Covered Entity Details
Entity Name
ST. MARYS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210028
Entity Address
25500 POINT LOOKOUT RD
LEONARDTOWN, MD 20650
Medicare Provider Number
210028
Participating Start Date
7/1/2016
Last Recertification Date
11/15/2017
Entity Termination Date
8/27/2018
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
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Daniel M. Feeley, Interim Chief Financial Officer
(301) 877-5527
Contract Pharmacy Representative
Coram Healthcare Corp of Greater DC
Brenda L Matthews, Branch Manager
(800) 227-3675
Signed By Date
10/11/2017
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