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MEDSTAR PHARMACY STORE # 12
DSH210015 FRANKLIN SQUARE HOSPITAL
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Covered Entity Details
Entity Name
FRANKLIN SQUARE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210015
Entity Address
9000 FRANKLIN SQUARE DR
BALTIMORE, MD 21237
Medicare Provider Number
210015
Participating Start Date
4/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MEDSTAR PHARMACY STORE # 12
Pharmacy Address
9000 FRANKLIN SQUARE DR
ROSEDALE, MD 21237-3901
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
MedStar Health
Bonnie Levin, AVP, Pharmacy Services
(410) 772-6773
Signed By Date
10/12/2017
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