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CORAM ALTERNATE SITE SERVICES, INC.
DSH210024 UNION MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
UNION MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210024
Entity Address
201 E UNIVERSITY PARKWAY
BALTIMORE, MD 21218
Medicare Provider Number
210024
Participating Start Date
10/1/2010
Last Recertification Date
8/23/2024
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
6/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Deana Stout, VP FINANCE
(410) 554-2228
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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