340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GOOD HEALTH PHARMACY AT HANOVER
DSH210013 Grace Medical Center, Inc.
Print
Covered Entity Details
Entity Name
Grace Medical Center, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210013
Entity Address
2000 WEST BALTIMORE STREET
BALTIMORE, MD 21223
Medicare Provider Number
210013
Participating Start Date
10/1/2002
Last Recertification Date
9/10/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
GOOD HEALTH PHARMACY AT HANOVER
Pharmacy Address
8200 MEADOWBRIDGE RD STE 301
MECHANICSVILLE, VA 23116-2337
Pharmacy Comments
Contract Details
Approval Date
12/10/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shelly Buck, COO/CNO
(410) 362-3618
Contract Pharmacy Representative
Good Health Pharmacy
Amanda Matassa, Pharmacist in Charge
(804) 442-3754
Signed By Date
12/10/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session