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CORAM ALTERNATE SITE SERVICES, INC.
DSH210062 MEDSTAR SOUTHERN MARYLAND HOSPITAL C
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Covered Entity Details
Entity Name
MEDSTAR SOUTHERN MARYLAND HOSPITAL C
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210062
Entity Address
7503 SURRATTS ROAD
CLINTON, MD 20735
Medicare Provider Number
210062
Participating Start Date
10/1/2015
Last Recertification Date
8/21/2024
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
10/13/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/9/2023
Business decision by covered entity and/or pharmacy
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
10/13/2017
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