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CORAM HEALTHCARE CORPORATION OF GREATER
DSH090004 Georgetown University Hospital
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Covered Entity Details
Entity Name
Georgetown University Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH090004
Entity Address
3800 Reservoir Road, NW
Washington, DC 20007
Medicare Provider Number
090004
Participating Start Date
4/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CORAM HEALTHCARE CORPORATION OF GREATER
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
7150 COLUMBIA GATEWAY DRIVE
SUITE E
COLUMBIA, MD 21046
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
12/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David C Ho, VP of Finance
(202) 444-4724
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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