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CORAM ALTERNATE SITE SERVICES, INC.
DSH210034 HARBOR HOSPITAL INC.
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Covered Entity Details
Entity Name
HARBOR HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210034
Entity Address
3001 SOUTH HANOVER STREET
BALTIMORE, MD 21225
Medicare Provider Number
210034
Participating Start Date
10/1/2003
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CORAM ALTERNATE SITE SERVICES, INC.
Pharmacy Address
CORAM CVS/SPECIALTY INFUSION SERVICES
1574 EAST PARHAM ROAD
RICHMOND, VA 23228-2360
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert P. Lally Jr., CFO
(443) 777-7257
Contract Pharmacy Representative
Coram Healthcare Corp of Greater DC
Brenda L Matthews, Branch Manager
(800) 227-3675
Signed By Date
10/12/2017
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