Contract Pharmacy Details

CORAM HEALTHCARE CORPORATION OF GREATER
DSH210002 UNIVERSITY OF MARYLAND MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF MARYLAND MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210002

Entity Address

22 SOUTH GREENE STREET
BALTIMORE, MD 21201

Medicare Provider Number

210002

Participating Start Date

10/1/2001

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

CORAM HEALTHCARE CORPORATION OF GREATER

Pharmacy Address

DBA CORAM CVS/SPECIALTY INFUSION SERVICE
4115 PLEASANT VALLEY DRIVE
SUITE 200
CHANTILLY, VA 20151

Pharmacy Comments

Contract Details

Approval Date

10/17/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/6/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Keith D. Persinger, Executive Vice President – Chief Operating & Financial Officer
(410) 328-1382

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/17/2017

340B Drug Pricing Program Database