Covered Entity Details

CHC10591-00 COMMUNITY CLINIC, INC. (Active) - information as of 5/7/2025 10:44:28 PM

Main Details

Name

COMMUNITY CLINIC, INC.

Subdivision Name

CCI-Takoma Park

Type

HRSA-Funded Health Center

Site ID

BPS-H80-007693

340B ID

CHC10591-00

Grant Number

H80CS10591

Additional Details

Current Program Status

Active

Registration Date

6/18/2009

Participating Start Date

4/1/2005

Participating Approval Date

6/18/2009

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Community Clinic, Inc. (CCI)
Sonya J. Bruton, CEO and President
(240) 839-5107

Primary Contact

CCI Health and Wellness
marvhe howard, Pharmacy Director
(667) 770-6534

Addresses

Street Address

7676 NEW HAMPSHIRE AVENUE
Suite 200
TAKOMA PARK, MD 20912

Billing Address

COMMUNITY CLINIC, INC. (ADMINISTRATIVE OFFICE)
8630 Fenton St, SUITE 1204
Silver Spring, MD 20910

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
6/18/09 SUITE CHANGE (WAS 200) AND ADDED MEDICAID#; 7/28/05 - NEW CONTACT	08/06/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MD	130061000	1790730281

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/05/2024	04/01/2024		04/01/2024
Contract Detail	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	01/15/2021	04/01/2021	08/01/2023	10/10/2023
Contract Detail	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	10/07/2013	01/01/2014	09/01/2018	09/01/2018
Contract Detail	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	01/03/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/13/2022	07/01/2022		07/01/2022
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/13/2022	07/01/2022		07/01/2022
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/18/2022	04/01/2022		04/01/2022
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/14/2022	01/01/2023		01/01/2023
Contract Detail	DIAMOND DRUGS INC	226 E DIAMOND AVE		GAITHERSBURG	MD	20877	01/12/2017	04/01/2017	03/16/2018	03/16/2018
Contract Detail	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 02330	110 CARROLL STREET NW	WASHINGTON	DC	20012	04/13/2022	07/01/2022		07/01/2022
Contract Detail	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 04546	2129 14TH STREET NW	WASHINGTON	DC	20009	04/13/2022	07/01/2022		07/01/2022
Contract Detail	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 07218	400 MASSACHUSETTS AVE., NW	WASHINGTON	DC	20001	04/13/2022	07/01/2022	02/28/2023	02/28/2023
Contract Detail	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	CVS PHARMACY # 17333	3100 14TH ST NW	WASHINGTON	DC	20010	04/13/2022	07/01/2022		07/01/2022
Contract Detail	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	CVS/PHARMACY # 10685	675 K STREET NW	WASHINGTON	DC	20001	04/18/2023	07/01/2023		07/01/2023
Contract Detail	GIANT PHARMACY #192	18250 FLOWER HILL WAY		GAITHERSBURG	MD	20879	07/27/2011	07/27/2011	06/30/2017	10/13/2017
Contract Detail	LANGLEY PARK PHARMACY	LANGLEY PARK PHARMACY	7676 NEW HAMPSHIRE AVENUE SUITE 104	TAKOMA PARK	MD	20912	04/01/2005	10/20/2011	01/16/2017	10/13/2017
Contract Detail	LANGLEY PARK PHARMACY & MEDICAL SUPPLIES	LANGLEY PARK PHARMACY & MEDICAL SUPPLIES	8004 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783	04/13/2022	07/01/2022	08/01/2023	10/10/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	07/15/2020	10/01/2020		10/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	01/18/2022	04/01/2022	03/29/2023	04/24/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	01/18/2022	04/01/2022	04/27/2022	05/10/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	01/18/2022	04/01/2022	04/13/2023	04/24/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	01/18/2022	04/01/2022	01/13/2023	01/13/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	01/18/2022	04/01/2022		04/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00169	799 ROCKVILLE PIKE	ROCKVILLE	MD	20852	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01443	7401 ANNAPOLIS RD.	LANDOVER HILLS	MD	20784	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01448	8201 ANNAPOLIS RD.	NEW CARROLLTON	MD	20784	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01452	12215 DARNESTOWN ROAD	GAITHERSBURG	MD	20878	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01465	2210 VIERS MILL ROAD	ROCKVILLE	MD	20851	04/13/2022	07/01/2022	08/29/2022	09/23/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01479	6917 ARLINGTON ROAD	BETHESDA	MD	20814	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01485	13729 CONNECTICUT AVE.	WHEATON	MD	20906	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01489	6516 LANDOVER ROAD	LANDOVER	MD	20785	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01498	13320 LAUREL-BOWIE ROAD	LAUREL	MD	20708	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01504	17651 REDLAND ROAD	DERWOOD	MD	20855	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01516	9420 LANHAM-SEVERN ROAD	SEABROOK	MD	20706	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01881	10095 WARD RD DUNKIRK MARKETPLACE	DUNKIRK	MD	20754	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02373	3605 EAST WEST HIGHWAY	HYATTSVILLE	MD	20782	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #3047	8601 MARTIN LUTHER KING JR HIGHWAY	LANHAM	MD	20706	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05460	19901 FREDERICK RD.,	GERMANTOWN	MD	20876	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10398	20 UPPER ROCK CIRCLE	ROCKVILLE	MD	20850	04/13/2022	07/01/2022		07/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16502	12000 CHERRY HILL RD	SILVER SPRING	MD	20904	07/14/2022	10/01/2022		10/01/2022
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16396	3343 CORRIDOR MARKETPLACE	LAUREL	MD	20724	10/14/2022	01/01/2023		01/01/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01495	11729 BELTSVILLE DR CALVERTON S/C	BELTSVILLE	MD	20705	01/11/2023	04/01/2023		04/01/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01468	10141 COLESVILLE ROAD	SILVER SPRING	MD	20901	04/18/2023	07/01/2023		07/01/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01513	9920 KEY WEST AVE	ROCKVILLE	MD	20850	10/10/2023	01/01/2024		01/01/2024
Contract Detail	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	01/14/2021	04/01/2021	09/01/2022	10/11/2022
Contract Detail	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	10/07/2013	01/01/2014	09/01/2018	09/01/2018
Contract Detail	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	01/03/2019	04/01/2019		04/01/2019
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/18/2022	04/01/2022		04/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/18/2022	04/01/2022		04/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/18/2022	04/01/2022		04/01/2022
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY# 11235	9555 KINGS CHARTER DR., SUITE D	ASHLAND	VA	23005	04/13/2022	07/01/2022	05/15/2023	05/18/2023
Contract Detail	SAFEWAY PHARMACY	909 THAYER AVENUE		SILVER SPRING	MD	20910	07/27/2011	07/27/2011	08/01/2018	08/09/2018
Contract Detail	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	01/14/2021	04/01/2021	10/01/2023	10/10/2023
Contract Detail	VINIULTRARX	ULTRA CARE PHARMACY	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874	09/29/2023	10/01/2023		10/01/2023
Contract Detail	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	01/18/2022	04/01/2022		04/01/2022
Contract Detail	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	01/18/2022	04/01/2022		04/01/2022
Contract Detail	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01840	8628 RICHMOND HWY, RTE 1 ENGLESIDE PLZ	ALEXANDRIA	VA	22309	04/13/2022	07/01/2022		07/01/2022
Contract Detail	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2750	1201 SOUTH HAYES ST.	ARLINGTON	VA	22202	04/13/2022	07/01/2022		07/01/2022
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/15/2020	01/01/2021	01/01/2021	04/30/2021
Contract Detail	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/12/2017	04/01/2017	09/01/2018	09/01/2018
Contract Detail	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	10/15/2020	01/01/2021	01/01/2021	04/30/2021
Contract Detail	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/12/2017	04/01/2017	09/01/2018	09/01/2018
Contract Detail	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	10/15/2020	01/01/2021	01/01/2021	04/30/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/15/2020	01/01/2021	01/01/2021	04/30/2021
Contract Detail	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	10/01/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	10/01/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	10/01/2020	01/01/2021	03/20/2025	03/20/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	10/01/2020	01/01/2021	02/19/2024	04/03/2024
Contract Detail	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	10/01/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	10/01/2020	01/01/2021	03/25/2025	03/25/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	10/01/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	04/01/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	04/01/2021	07/01/2021		07/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #17803	9139 RIGGS RD	ADELPHI	MD	20783	10/14/2022	01/01/2023	06/29/2023	08/11/2023
Contract Detail	WALGREEN CO.	WALGREENS #19851	10456 BALTIMORE AVE	BELTSVILLE	MD	20705	04/04/2025	07/01/2025		04/04/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/14/2022	01/01/2023		01/01/2023
Contract Detail	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	10/15/2020	01/01/2021	01/01/2021	04/30/2021

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CHC10591-00	Active	BPS-H80-007693	COMMUNITY CLINIC, INC.	CCI-Takoma Park	7676 NEW HAMPSHIRE AVENUE	Suite 200	TAKOMA PARK	MD
CHC10591-02	Active	BPS-H80-019269	COMMUNITY CLINIC, INC.	CCI-GAITHERSBURG	220 GIRARD ST		GAITHERSBURG	MD
CHC10591-03	Active	BPS-H80-012550	COMMUNITY CLINIC, INC.	CCI-SILVER SPRING	8630 Fenton Street	Suite 1200	SILVER SPRING	MD
CHC10591-05	Terminated	BPS-H80-012721	COMMUNITY CLINIC, INC., THE	CCI-Greenbelt	7615 Ora Glen Drive		Greenbelt	MD
CHC10591-06	Terminated	BPS-H80-012632	COMMUNITY CLINIC, INC., THE	CCI - Silver Spring Community Vision	8210 Dixon Ave.		Silver Spring	MD
CHC10591-07	Active	BPS-H80-008762	COMMUNITY CLINIC, INC., THE	CCI Gaithersburg Dental	200 Girard St. STE 206		Gaithersburg	MD
CHC10591-08	Terminated	BPS-H80-012481	COMMUNITY CLINIC, INC., THE	CCI - Family Services Inc.	610 E Diamond Ave STE 300		Gaithersburg	MD
CHC10591-09	Active	BPS-H80-027179	COMMUNITY CLINIC, INC., THE	CCI-Greenway	7474 Greenway Center Drive		Greenbelt	MD
CHC10591-10	Terminated	BPS-H80-012463	COMMUNITY CLINIC, INC., THE	Community Clinic Inc	8630 Fenton Street		Silver Spring	MD
CHC10591-11	Terminated	BPS-H80-012992	COMMUNITY CLINIC, INC., THE	Community Clinic at WAH	7620 Carroll Avenue	Suite 101	Takoma Park	MD
CHC10591-12	Terminated	BPS-H80-013544	COMMUNITY CLINIC, INC., THE	Community Clinic Inc. - TAYA	1400 Spring Street, Suite 200		Silver Spring	MD
CHC10591-13	Active	BPS-H80-031873	Community Clinic, Inc., The	CCI-Wheaton	2730 University Blvd W Ste ll10		Wheaton	MD
CHC10591-14	Active	BPS-H80-019267	Community Clinic, Inc., The	CCI-Rockville	2 Taft Ct		Rockville	MD
CHC10591-15	Active	BPS-H80-038938	THE COMMUNITY CLINIC, INC.	CCI-Ora Glen	7615 Ora Glen Dr		Greenbelt	MD

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC10591-00	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/01/2024
CHC10591-00	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	04/01/2021	08/01/2023
CHC10591-02	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	04/01/2021	08/01/2023
CHC10591-03	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	04/01/2021	08/01/2023
CHC10591-05	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	04/01/2021	08/01/2023
CHC10591-07	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	04/01/2021	08/01/2023
CHC10591-09	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	04/01/2021	08/01/2023
CHC10591-10	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	04/01/2021	07/01/2022
CHC10591-14	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	10/01/2021	08/01/2023
CHC10591-13	ALTRUIX	601 CHINQUAPIN ROUND RD		ANNAPOLIS	MD	21401	10/01/2021	08/01/2023
CHC10591-02	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	01/01/2014
CHC10591-03	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	01/01/2014
CHC10591-00	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	01/01/2014	09/01/2018
CHC10591-00	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	04/01/2019
CHC10591-05	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	04/01/2019	04/01/2025
CHC10591-08	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	04/01/2019	01/01/2020
CHC10591-09	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	04/01/2019
CHC10591-14	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	10/01/2021
CHC10591-13	AVITA PHARMACY 1060	RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH	40 PENNWOOD PL STE 200	WARRENDALE	PA	15086-6625	10/01/2021
CHC10591-00	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CHC10591-02	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CHC10591-03	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CHC10591-05	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022	04/01/2025
CHC10591-07	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CHC10591-09	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CHC10591-10	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022	07/01/2022
CHC10591-13	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CHC10591-14	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/01/2022
CHC10591-00	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CHC10591-02	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CHC10591-03	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CHC10591-05	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022	04/01/2025
CHC10591-07	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CHC10591-09	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CHC10591-10	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022	07/01/2022
CHC10591-13	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CHC10591-14	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2022
CHC10591-00	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CHC10591-02	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CHC10591-03	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CHC10591-05	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022	04/01/2025
CHC10591-07	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CHC10591-09	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CHC10591-10	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022	07/01/2022
CHC10591-13	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CHC10591-14	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/01/2022
CHC10591-00	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CHC10591-02	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CHC10591-03	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CHC10591-05	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022	04/01/2025
CHC10591-07	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CHC10591-09	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CHC10591-10	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022	07/01/2022
CHC10591-13	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CHC10591-14	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/01/2022
CHC10591-00	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CHC10591-02	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CHC10591-03	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CHC10591-05	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022	04/01/2025
CHC10591-07	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CHC10591-09	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CHC10591-10	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022	07/01/2022
CHC10591-13	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CHC10591-14	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/01/2022
CHC10591-00	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CHC10591-02	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CHC10591-03	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CHC10591-05	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022	04/01/2025
CHC10591-07	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CHC10591-09	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CHC10591-10	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022	07/01/2022
CHC10591-13	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CHC10591-14	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/01/2022
CHC10591-00	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CHC10591-02	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CHC10591-03	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CHC10591-05	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022	04/01/2025
CHC10591-07	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CHC10591-09	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CHC10591-10	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022	07/01/2022
CHC10591-13	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CHC10591-14	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/01/2022
CHC10591-00	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CHC10591-02	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CHC10591-03	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CHC10591-05	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022	04/01/2025
CHC10591-07	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CHC10591-09	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CHC10591-10	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022	07/01/2022
CHC10591-13	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CHC10591-14	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/01/2022
CHC10591-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CHC10591-02	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CHC10591-03	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CHC10591-05	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022	04/01/2025
CHC10591-07	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CHC10591-09	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CHC10591-10	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022	07/01/2022
CHC10591-13	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CHC10591-14	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/01/2022
CHC10591-00	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CHC10591-02	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CHC10591-03	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CHC10591-05	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022	04/01/2025
CHC10591-07	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CHC10591-09	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CHC10591-10	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022	07/01/2022
CHC10591-13	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CHC10591-14	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/01/2022
CHC10591-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2022
CHC10591-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2022
CHC10591-00	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CHC10591-02	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CHC10591-03	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CHC10591-05	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022	04/01/2025
CHC10591-07	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CHC10591-09	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CHC10591-10	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022	07/01/2022
CHC10591-13	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CHC10591-14	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/01/2022
CHC10591-00	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2023
CHC10591-00	DIAMOND DRUGS INC	226 E DIAMOND AVE		GAITHERSBURG	MD	20877	04/01/2017	03/16/2018
CHC10591-00	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 02330	110 CARROLL STREET NW	WASHINGTON	DC	20012	07/01/2022
CHC10591-00	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 04546	2129 14TH STREET NW	WASHINGTON	DC	20009	07/01/2022
CHC10591-00	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	DBA: CVS/PHARMACY # 07218	400 MASSACHUSETTS AVE., NW	WASHINGTON	DC	20001	07/01/2022	02/28/2023
CHC10591-00	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	CVS PHARMACY # 17333	3100 14TH ST NW	WASHINGTON	DC	20010	07/01/2022
CHC10591-00	DISTRICT OF COLUMBIA CVS PHARMACY, L.L.C	CVS/PHARMACY # 10685	675 K STREET NW	WASHINGTON	DC	20001	07/01/2023
CHC10591-00	GIANT PHARMACY #192	18250 FLOWER HILL WAY		GAITHERSBURG	MD	20879	07/27/2011	06/30/2017
CHC10591-00	LANGLEY PARK PHARMACY	LANGLEY PARK PHARMACY	7676 NEW HAMPSHIRE AVENUE SUITE 104	TAKOMA PARK	MD	20912	10/20/2011	01/16/2017
CHC10591-00	LANGLEY PARK PHARMACY & MEDICAL SUPPLIES	LANGLEY PARK PHARMACY & MEDICAL SUPPLIES	8004 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783	07/01/2022	08/01/2023
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2020
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2020
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2020
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2020
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2020
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2020
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2020	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2020	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2020	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2020	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2020	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2020	07/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2020
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2020
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2020
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2020
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2020
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2020
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2020
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2020
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2020
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020	04/01/2025
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2020
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2020
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2020	04/01/2025
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020	04/01/2025
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2020
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2020	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2020	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2020	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2020	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2020	04/01/2025
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2020
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2020
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2020
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2020
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2020
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2020
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2020
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2021
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2021
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2021
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2021
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2021
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2021
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2021
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01453	5707 RIVERDALE ROAD	RIVERDALE	MD	20737	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00452	7607 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16639	6100 GREENBELT RD	GREENBELT	MD	20770	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02016	5910 GREENBELT ROAD	GREENBELT	MD	20770	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01434	7939 NEW HAMPSHIRE AVE	HYATTSVILLE	MD	20783-4609	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01490	546 NORTH FREDERICK AVENUE	GAITHERSBURG	MD	20877	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01501	19100 MONTGOMERY VILLAGE AVE.	GAITHERSBURG	MD	20886	10/01/2021
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01459	12359 GEORGIA AVENUE	SILVER SPRING	MD	20906	10/01/2021
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022
CHC10591-02	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022	04/01/2025
CHC10591-05	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022	04/01/2025
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-07	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-09	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022	07/01/2022
CHC10591-10	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022	07/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-13	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01431	3110 OLNEY SANDY SPRING RD.	OLNEY	MD	20832	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01445	360 HUNGERFORD DR., SPACE 410	ROCKVILLE	MD	20850	04/01/2022	04/27/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01461	15600 COLUMBIA PIKE	BURTONSVILLE	MD	20866	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17010	3500 EAST WEST HWY STE 1200	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10168	8319 BALTIMORE AVE.	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01521	9140 ROTHBURY DRIVE	GAITHERSBURG	MD	20886	04/01/2022	04/13/2023
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01463	1301 LAMBERTON DRIVE	SILVER SPRING	MD	20902	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01177	11190 VIERS MILL ROAD	WHEATON	MD	20902	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01439	10113 NEW HAMPSHIRE AVENUE	SILVER SPRING	MD	20903	04/01/2022	03/29/2023
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01499	2271 BEL PRE ROAD	SILVER SPRING	MD	20906	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 3517	825 WAYNE AVE.	SILVER SPRING	MD	20910	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05706	7095 BALTIMORE ANNAPOLIS BLVD.	GLEN BURNIE	MD	21061	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02778	11100 BALTIMORE AVE.	BELTSVILLE	MD	20705	04/01/2022	01/13/2023
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01790	15100 BALTIMORE AVE.	LAUREL	MD	20707	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01514	3611 BLADENSBURG ROAD	COLMAR MANOR	MD	20722	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01444	7300 BALTIMORE AVE	COLLEGE PARK	MD	20740	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01456	10692 CAMPUS WAY S KETTERING S/C	UPPER MARLBORO	MD	20774	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01486	5621 SARGENT ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-14	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01436	3130 QUEENS CHAPEL ROAD	HYATTSVILLE	MD	20782	04/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00169	799 ROCKVILLE PIKE	ROCKVILLE	MD	20852	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01443	7401 ANNAPOLIS RD.	LANDOVER HILLS	MD	20784	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01448	8201 ANNAPOLIS RD.	NEW CARROLLTON	MD	20784	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01452	12215 DARNESTOWN ROAD	GAITHERSBURG	MD	20878	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01465	2210 VIERS MILL ROAD	ROCKVILLE	MD	20851	07/01/2022	08/29/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01479	6917 ARLINGTON ROAD	BETHESDA	MD	20814	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01485	13729 CONNECTICUT AVE.	WHEATON	MD	20906	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01489	6516 LANDOVER ROAD	LANDOVER	MD	20785	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01498	13320 LAUREL-BOWIE ROAD	LAUREL	MD	20708	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01504	17651 REDLAND ROAD	DERWOOD	MD	20855	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01516	9420 LANHAM-SEVERN ROAD	SEABROOK	MD	20706	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01881	10095 WARD RD DUNKIRK MARKETPLACE	DUNKIRK	MD	20754	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02373	3605 EAST WEST HIGHWAY	HYATTSVILLE	MD	20782	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #3047	8601 MARTIN LUTHER KING JR HIGHWAY	LANHAM	MD	20706	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05460	19901 FREDERICK RD.,	GERMANTOWN	MD	20876	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10398	20 UPPER ROCK CIRCLE	ROCKVILLE	MD	20850	07/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16502	12000 CHERRY HILL RD	SILVER SPRING	MD	20904	10/01/2022
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 16396	3343 CORRIDOR MARKETPLACE	LAUREL	MD	20724	01/01/2023
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01495	11729 BELTSVILLE DR CALVERTON S/C	BELTSVILLE	MD	20705	04/01/2023
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01468	10141 COLESVILLE ROAD	SILVER SPRING	MD	20901	07/01/2023
CHC10591-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01513	9920 KEY WEST AVE	ROCKVILLE	MD	20850	01/01/2024
CHC10591-00	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	04/01/2021	09/01/2022
CHC10591-02	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	04/01/2021	09/01/2022
CHC10591-03	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	04/01/2021	09/01/2022
CHC10591-05	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	04/01/2021	09/01/2022
CHC10591-07	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	04/01/2021	09/01/2022
CHC10591-09	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	04/01/2021	09/01/2022
CHC10591-10	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	04/01/2021	07/01/2022
CHC10591-14	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	10/01/2021	09/01/2022
CHC10591-13	MEDLY BALTIMORE INC.	MEDLY PHARMACY	300 SAINT PAUL PL	BALTIMORE	MD	21202-2120	10/01/2021	09/01/2022
CHC10591-02	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	01/01/2014
CHC10591-03	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	01/01/2014
CHC10591-00	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	01/01/2014	09/01/2018
CHC10591-00	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	04/01/2019
CHC10591-05	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	04/01/2019	04/01/2025
CHC10591-08	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	04/01/2019	01/01/2020
CHC10591-09	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	04/01/2019
CHC10591-14	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	10/01/2021
CHC10591-13	PHARMBLUE LLC DBA AVITA PHARMACY 1059	1226 CHESTNUT ST		PHILADELPHIA	PA	19107	10/01/2021
CHC10591-00	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CHC10591-02	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CHC10591-03	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CHC10591-05	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022	04/01/2025
CHC10591-07	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CHC10591-09	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CHC10591-10	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022	07/01/2022
CHC10591-13	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CHC10591-14	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2022
CHC10591-00	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CHC10591-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CHC10591-02	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CHC10591-02	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CHC10591-03	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CHC10591-03	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CHC10591-05	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022	04/01/2025
CHC10591-05	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022	04/01/2025
CHC10591-07	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CHC10591-07	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CHC10591-09	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CHC10591-09	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CHC10591-10	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022	07/01/2022
CHC10591-10	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022	07/01/2022
CHC10591-13	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CHC10591-13	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CHC10591-14	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/01/2022
CHC10591-14	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/01/2022
CHC10591-00	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY# 11235	9555 KINGS CHARTER DR., SUITE D	ASHLAND	VA	23005	07/01/2022	05/15/2023
CHC10591-00	SAFEWAY PHARMACY	909 THAYER AVENUE		SILVER SPRING	MD	20910	07/27/2011	08/01/2018
CHC10591-00	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	04/01/2021	10/01/2023
CHC10591-02	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	04/01/2021	10/01/2023
CHC10591-03	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	04/01/2021	10/01/2023
CHC10591-05	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	04/01/2021	10/01/2023
CHC10591-07	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	04/01/2021	10/01/2023
CHC10591-09	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	04/01/2021	10/01/2023
CHC10591-10	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	04/01/2021	07/01/2022
CHC10591-14	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	10/01/2021	10/01/2023
CHC10591-13	ULTRA CARE PHARMACY	UR CARE PHARMACY MD LLC	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874-5259	10/01/2021	10/01/2023
CHC10591-00	VINIULTRARX	ULTRA CARE PHARMACY	12619 WISTERIA DR STE A	GERMANTOWN	MD	20874	10/01/2023
CHC10591-00	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022
CHC10591-00	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022
CHC10591-02	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022
CHC10591-02	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022
CHC10591-03	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022
CHC10591-03	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022
CHC10591-05	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022	04/01/2025
CHC10591-05	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022	04/01/2025
CHC10591-07	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022
CHC10591-07	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022
CHC10591-09	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022
CHC10591-09	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022
CHC10591-10	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022	07/01/2022
CHC10591-10	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022	07/01/2022
CHC10591-13	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022
CHC10591-13	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022
CHC10591-14	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02317	6637 ARLINGTON BLVD.	FALLS CHURCH	VA	22042	04/01/2022
CHC10591-14	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01397	1452 CHAIN BRIDGE ROAD	MCLEAN	VA	22101	04/01/2022
CHC10591-00	VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01840	8628 RICHMOND HWY, RTE 1 ENGLESIDE PLZ	ALEXANDRIA	VA	22309	07/01/2022
CHC10591-00	VIRGINIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2750	1201 SOUTH HAYES ST.	ARLINGTON	VA	22202	07/01/2022
CHC10591-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2021	01/01/2021
CHC10591-02	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2021	01/01/2021
CHC10591-03	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2021	01/01/2021
CHC10591-05	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2021	01/01/2021
CHC10591-07	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2021	01/01/2021
CHC10591-09	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2021	01/01/2021
CHC10591-10	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2021	01/01/2021
CHC10591-00	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	04/01/2017	09/01/2018
CHC10591-00	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/01/2021	01/01/2021
CHC10591-02	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/01/2021	01/01/2021
CHC10591-03	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/01/2021	01/01/2021
CHC10591-05	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/01/2021	01/01/2021
CHC10591-07	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/01/2021	01/01/2021
CHC10591-09	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/01/2021	01/01/2021
CHC10591-10	WAL-MART PHARMACY 10-2357	20910 FREDERICK ROAD		GERMANTOWN	MD	20876	01/01/2021	01/01/2021
CHC10591-00	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	04/01/2017	09/01/2018
CHC10591-00	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/01/2021	01/01/2021
CHC10591-02	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/01/2021	01/01/2021
CHC10591-03	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/01/2021	01/01/2021
CHC10591-05	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/01/2021	01/01/2021
CHC10591-07	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/01/2021	01/01/2021
CHC10591-09	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/01/2021	01/01/2021
CHC10591-10	WAL-MART PHARMACY 10-5129	6210 ANNAPOLIS RD		LANDOVER HILLS	MD	20784	01/01/2021	01/01/2021
CHC10591-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2021	01/01/2021
CHC10591-02	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2021	01/01/2021
CHC10591-03	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2021	01/01/2021
CHC10591-05	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2021	01/01/2021
CHC10591-07	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2021	01/01/2021
CHC10591-09	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2021	01/01/2021
CHC10591-10	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2021	01/01/2021
CHC10591-00	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	01/01/2021
CHC10591-02	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	01/01/2021
CHC10591-03	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	01/01/2021
CHC10591-05	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	01/01/2021	04/01/2025
CHC10591-07	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	01/01/2021
CHC10591-09	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	01/01/2021
CHC10591-10	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	01/01/2021	07/01/2022
CHC10591-14	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	10/01/2021
CHC10591-13	WALGREEN CO	COMMUNITY A WALGREENS PHARMACY #15298	1325 14TH STREET NW	WASHINGTON	DC	20005	10/01/2021
CHC10591-00	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	01/01/2021
CHC10591-00	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	01/01/2021	03/20/2025
CHC10591-00	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	01/01/2021	02/19/2024
CHC10591-00	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	01/01/2021
CHC10591-00	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	01/01/2021	03/25/2025
CHC10591-00	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	01/01/2021
CHC10591-02	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	01/01/2021
CHC10591-02	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	01/01/2021	03/20/2025
CHC10591-02	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	01/01/2021	02/19/2024
CHC10591-02	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	01/01/2021
CHC10591-02	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	01/01/2021	03/25/2025
CHC10591-02	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	01/01/2021
CHC10591-03	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	01/01/2021
CHC10591-03	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	01/01/2021	03/20/2025
CHC10591-03	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	01/01/2021	02/19/2024
CHC10591-03	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	01/01/2021
CHC10591-03	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	01/01/2021	03/25/2025
CHC10591-03	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	01/01/2021
CHC10591-05	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	01/01/2021	04/01/2025
CHC10591-05	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	01/01/2021	04/01/2025
CHC10591-05	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	01/01/2021	02/19/2024
CHC10591-05	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	01/01/2021	04/01/2025
CHC10591-05	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	01/01/2021	04/01/2025
CHC10591-05	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	01/01/2021	04/01/2025
CHC10591-07	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	01/01/2021
CHC10591-07	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	01/01/2021	03/20/2025
CHC10591-07	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	01/01/2021	02/19/2024
CHC10591-07	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	01/01/2021
CHC10591-07	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	01/01/2021	03/25/2025
CHC10591-07	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	01/01/2021
CHC10591-09	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	01/01/2021
CHC10591-09	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	01/01/2021	03/20/2025
CHC10591-09	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	01/01/2021	02/19/2024
CHC10591-09	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	01/01/2021
CHC10591-09	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	01/01/2021	03/25/2025
CHC10591-09	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	01/01/2021
CHC10591-10	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	01/01/2021	07/01/2022
CHC10591-10	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	01/01/2021	07/01/2022
CHC10591-10	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	01/01/2021	07/01/2022
CHC10591-10	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	01/01/2021	07/01/2022
CHC10591-10	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	01/01/2021	07/01/2022
CHC10591-10	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	01/01/2021	07/01/2022
CHC10591-00	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	07/01/2021
CHC10591-00	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	07/01/2021
CHC10591-02	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	07/01/2021
CHC10591-02	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	07/01/2021
CHC10591-03	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	07/01/2021
CHC10591-03	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	07/01/2021
CHC10591-05	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	07/01/2021	04/01/2025
CHC10591-05	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	07/01/2021	04/01/2025
CHC10591-07	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	07/01/2021
CHC10591-07	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	07/01/2021
CHC10591-09	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	07/01/2021
CHC10591-09	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	07/01/2021
CHC10591-10	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	07/01/2021	07/01/2022
CHC10591-10	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	07/01/2021	07/01/2022
CHC10591-14	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	10/01/2021	02/19/2024
CHC10591-14	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	10/01/2021
CHC10591-14	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	10/01/2021
CHC10591-14	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	10/01/2021	03/25/2025
CHC10591-14	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	10/01/2021
CHC10591-14	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	10/01/2021	03/20/2025
CHC10591-14	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	10/01/2021
CHC10591-14	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	10/01/2021
CHC10591-13	WALGREEN CO.	DBA: WALGREENS #12846	6498 LANDOVER ROAD	CHEVERLY	MD	20785	10/01/2021	03/25/2025
CHC10591-13	WALGREEN CO.	DBA: WALGREENS #11140	1329 UNIVERSITY BLVD. E	TAKOMA PARK	MD	20912	10/01/2021
CHC10591-13	WALGREEN CO.	DBA: WALGREENS #12817	11215 NEW HAMPSHIRE AVE	SILVER SPRING	MD	20904	10/01/2021	02/19/2024
CHC10591-13	WALGREEN CO.	WALGREENS #19966	19927 CENTURY BLVD	GERMANTOWN	MD	20874	10/01/2021
CHC10591-13	WALGREEN CO.	WALGREENS #17928	662 QUINCE ORCHARD RD	GAITHERSBURG	MD	20878	10/01/2021
CHC10591-13	WALGREEN CO.	WALGREENS #19619	8701 GEORGIA AVE STE 100	SILVER SPRING	MD	20910-3736	10/01/2021	03/20/2025
CHC10591-13	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21142	1015 RIPLEY STREET STE B	SILVER SPRING	MD	20910	10/01/2021
CHC10591-13	WALGREEN CO.	DBA: WALGREENS #11500	15990 ANNAPOLIS RD.	BOWIE	MD	20715	10/01/2021
CHC10591-00	WALGREEN CO.	WALGREENS #17803	9139 RIGGS RD	ADELPHI	MD	20783	01/01/2023	06/29/2023
CHC10591-00	WALGREEN CO.	WALGREENS #19851	10456 BALTIMORE AVE	BELTSVILLE	MD	20705	07/01/2025
CHC10591-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2023
CHC10591-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2023
CHC10591-00	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2023
CHC10591-00	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	01/01/2021	01/01/2021
CHC10591-02	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	01/01/2021	01/01/2021
CHC10591-03	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	01/01/2021	01/01/2021
CHC10591-05	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	01/01/2021	01/01/2021
CHC10591-07	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	01/01/2021	01/01/2021
CHC10591-09	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	01/01/2021	01/01/2021
CHC10591-10	WALMART PHARMACY 10-3035	310 RIGGS RD N.E.		WASHINGTON	DC	20011	01/01/2021	01/01/2021

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/1/2024 9:11:16 AM	2/10/2025 2:09:27 PM	2/10/2025 2:09 PM
Details	Last Recertification Date	Update	Recertification	2/2/2023 4:31:11 PM	2/1/2024 9:11:16 AM	2/1/2024 9:11 AM
Contacts	Primary Contact	Update	Profile Change Request	howard, marvhe Pharmacist CCI Health and Wellness 6677706534	howard, marvhe Pharmacy Director CCI Health and Wellness 6677706534	10/6/2023 1:52 PM
Contacts	Primary Contact	Update	PC Change Request	Harris, Brian O Chief Financial Officer CCI Health Services 6613810458	howard, marvhe Pharmacist CCI Health and Wellness 6677706534	10/2/2023 9:36 AM
Contacts	Primary Contact	Update	PC Change Request	Baror, Robert J Chief Legal Officer and General Counsel Community Clinic, Inc. 3013407525-1185	Harris, Brian O Chief Financial Officer CCI Health Services 6613810458	9/7/2023 5:24 PM
Details	Last Recertification Date	Update	Recertification	2/3/2022 11:56:28 AM	2/2/2023 4:31:11 PM	2/2/2023 4:31 PM
Contacts	Primary Contact	Update	Group Change Request	Mendoza, Veronica Clinic Manager Community Clinic, Inc. 2406381160	Baror, Robert J Chief Legal Officer and General Counsel Community Clinic, Inc. 3013407525-1185	5/12/2022 1:50 PM
Addresses	Main Address	Update	Change Request	7676 NEW HAMPSHIRE AVENUE Suite 220 TAKOMA PARK, MD 20912	7676 NEW HAMPSHIRE AVENUE Suite 200 TAKOMA PARK, MD 20912	4/4/2022 7:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/4/2022 7:31 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		130061000	4/4/2022 7:31 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	4/4/2022 7:31 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790730281	4/4/2022 7:31 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	4/4/2022 7:31 AM
Details	Entity Subname	Update	Change Request	Takoma Park	CCI-Takoma Park	4/4/2022 7:31 AM
Details	Last Recertification Date	Update	Recertification	2/4/2021 8:35:27 AM	2/3/2022 11:56:28 AM	2/3/2022 11:56 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1619287638 (MD)		6/3/2021 1:32 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1699817775 (MD)		6/3/2021 1:32 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1275876617 (MD)		6/3/2021 1:32 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1538406657 (MD)		6/3/2021 1:32 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1265676738 (MD)		6/3/2021 1:32 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790730281 (MD)		6/3/2021 1:32 PM
Details	Last Recertification Date	Update	Recertification	1/27/2020 3:06:02 PM	2/4/2021 8:35:27 AM	2/4/2021 8:35 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	777235100 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	072519600 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	051535300 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	589904400 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	421246100 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	214045400 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	535841800 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	488001300 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	115052900 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	051545100 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	514204100 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	510518800 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	962003600 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	816280800 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	047725700 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	405868200 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	101176600 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	432200200 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	407712100 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	712014100 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	078773600 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	102134600 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	083761000 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	777392700 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	854003900 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	654169100 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	584016300 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	567610000 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	460009600 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	698022800 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	118660400 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	918039700 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	714689200 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	207253000 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	184107600 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	330051000 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	406198500 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	236026800 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	596005300 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	207516400 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	882408800 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	888042500 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	999081000 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	692059400 (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	216649yvg (MD)		11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1g0397 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1770619181 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1073556221 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1568016608 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1043320815 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1184935397 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1346236775 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1053435990 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1952342628 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1780777458 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1477863884 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1831122969 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1063491686 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1952759375 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1679675797 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1033295506 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1992107296 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1255539276 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1962872333 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194829416 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1306833223 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134634538 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1467466656 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1528531209 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790853042 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1518386556 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1811454010 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1841410818 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1285697458 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1487692885 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1497080964 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1598147522 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1326151267 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1245358019 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1538706668 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558565531 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1588181630 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558649426 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1558970251 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1013201987 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1982144564 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134550296 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1063790129 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1023236866 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1134371966 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1952810475 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1225298482 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1649560608 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1841817467 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801375431 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1871136101 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801270996 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1780925222 (MD)		11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1619287638	11/17/2020 1:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1699817775	11/17/2020 1:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1275876617	11/17/2020 1:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1538406657	11/17/2020 1:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1265676738	11/17/2020 1:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	11/17/2020 1:30 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1790730281	11/17/2020 1:30 PM
Medicaid Billing	NPI: State	Insert	Change Request		MD	11/17/2020 1:30 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	555056400 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	555060200 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	777609800 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10117600 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	423216000 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	441154400 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	77392700 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	054003900584016300 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	741156100 (MD)		11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		047725700	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		405868200	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		101176600	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		432200200	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		407712100	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		712014100	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		078773600	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		102134600	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		083761000	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		777392700	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		854003900	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		654169100	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		584016300	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		567610000	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		460009600	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		698022800	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		118660400	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		918039700	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		714689200	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		207253000	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		184107600	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		330051000	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		406198500	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		236026800	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		596005300	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		207516400	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		882408800	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		888042500	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		999081000	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		692059400	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		216649yvg	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1g0397	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	11/9/2020 9:51 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	130061000 (MD)		11/9/2020 9:51 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1316467160 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1033117221 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1679950125 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1770094989 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1952426892 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1568431799 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1407158389 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1538349527 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1215228861 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1467932897 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1356421044 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1376609248 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1801231691 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1669982294 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508376484 (MD)		10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1326151267	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1245358019	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1538706668	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1558565531	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1588181630	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1558649426	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1558970251	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1013201987	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1982144564	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1134550296	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1063790129	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1023236866	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1134371966	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1952810475	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1225298482	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1649560608	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1841817467	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1801375431	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1871136101	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1801270996	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780925222	10/19/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	10/19/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1790730281 (MD)		10/19/2020 10:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		777235100	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		555056400	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		555060200	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		777609800	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10117600	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		072519600	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		051535300	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		589904400	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		421246100	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		214045400	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		535841800	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		488001300	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		115052900	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		051545100	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		514204100	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		423216000	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		441154400	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		77392700	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		510518800	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		962003600	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		816280800	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		054003900584016300	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		741156100	8/27/2020 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770619181	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1316467160	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1073556221	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1033117221	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1679950125	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1568016608	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1043320815	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1184935397	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1770094989	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1346236775	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1952426892	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1053435990	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1952342628	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1568431799	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1780777458	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1477863884	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1831122969	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1063491686	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1407158389	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1538349527	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1215228861	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1952759375	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1679675797	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1033295506	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1992107296	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1255539276	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1962872333	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1194829416	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306833223	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1134634538	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467932897	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467466656	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1528531209	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1356421044	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790853042	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1518386556	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1811454010	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1841410818	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1376609248	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1285697458	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1487692885	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1497080964	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1801231691	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1598147522	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1669982294	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1508376484	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Insert	Change Request		MD	8/27/2020 10:47 AM
Medicaid Billing	NPI: State	Update	Change Request		MD	8/27/2020 9:51 AM
Contacts	Authorizing Official	Update	AO Change Request	Knolhoff, Kathleen CEO & President Community Clinic, Inc. 2404992609	Bruton, Sonya J. CEO and President Community Clinic, Inc. (CCI) 2408395107	6/26/2020 6:28 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 12:39:47 PM	1/27/2020 3:06:02 PM	1/27/2020 3:06 PM
Addresses	Main Address	Update	Change Request	7676 NEW HAMPSHIRE AVENUE Suite 220-A TAKOMA PARK, MD 20912	7676 NEW HAMPSHIRE AVENUE Suite 220 TAKOMA PARK, MD 20912	12/10/2019 11:40 AM
Details	Last Recertification Date	Update	Recertification	2/9/2018 12:51:11 PM	1/29/2019 12:39:47 PM	1/29/2019 12:39 PM
Details	Last Recertification Date	Update	Recertification	2/2/2017 12:00:00 AM	2/9/2018 12:51:11 PM	2/9/2018 12:51 PM
Contacts	Primary Contact	Update	Change Request	Boettcher, Katherine MANAGER 2406381160	Mendoza, Veronica Clinic Manager Community Clinic, Inc. 2406381160	11/6/2017 11:21 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	13006100	130061000	10/17/2017 2:28 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1790730281	10/17/2017 2:28 PM
Contacts	Authorizing Official	Update	AO Change Request	Chang, Margaret Medical Director 2404992615	Knolhoff, Kathleen CEO & President Community Clinic, Inc. 2404992609	10/13/2017 2:32 PM
Addresses	Main Address	Insert			7676 NEW HAMPSHIRE AVENUE Suite 220-A TAKOMA PARK, MD 20912	2/15/2017 9:51 PM
Contacts	Primary Contact	Update		BONILLA, CLAUDIA MANAGER 2406381160	Boettcher, Katherine MANAGER 2406381160	2/15/2017 9:51 PM
Details	Last Recertification Date	Update		3/3/2016 12:00:00 AM	2/2/2017 12:00:00 AM	2/15/2017 9:51 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	3/3/2016 3:16 PM
Details	Last Recertification Date	Update		3/10/2015 12:00:00 AM	3/3/2016 12:00:00 AM	3/3/2016 3:16 PM
Details	Last Recertification Date	Update		3/4/2014 12:00:00 AM	3/10/2015 12:00:00 AM	3/10/2015 10:57 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/4/2014 12:00:00 AM	3/4/2014 5:02 PM
Addresses	Billing Address	Insert			COMMUNITY CLINIC, INC. (ADMINISTRATIVE OFFICE) 8630 Fenton St, SUITE 1204 Silver Spring, MD 20910	10/28/2013 10:29 AM
Details	Entity Subname	Update			Takoma Park	7/1/2013 5:16 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/4/2013 9:19 AM
Contacts	Authorizing Official	Insert			Chang, Margaret Medical Director 2404992615	12/28/2012 7:28 AM
Contacts	Primary Contact	Insert			BONILLA, CLAUDIA MANAGER 2406381160	12/19/2012 4:30 PM
Details	Last Recertification Date	Insert				8/6/2010 10:50 AM
Details	Grant Number	Insert			H80CS10591	8/6/2010 10:50 AM
Details	340B ID	Insert			CHC10591-00	8/6/2010 10:50 AM
Details	Is Authorizing Official EHB Data	Insert				8/6/2010 10:50 AM
Dates	Last Date That 340B Drugs Purchased	Insert				8/6/2010 10:50 AM
Details	Medicare Provider Number	Insert				8/6/2010 10:50 AM
Details	Entity Name	Insert			COMMUNITY CLINIC, INC.	8/6/2010 10:50 AM
Details	Program Code	Insert			CH	8/6/2010 10:50 AM
Details	Entity Subname	Insert				8/6/2010 10:50 AM
Dates	Participating Approval Date	Insert			6/18/2009 12:00:00 AM	8/6/2010 10:50 AM
Details	State	Insert			Active	8/6/2010 10:50 AM
Dates	Registration Date	Insert			6/18/2009 12:00:00 AM	8/6/2010 10:50 AM
Dates	Signed By Date	Insert				8/6/2010 10:50 AM
Dates	Start Date	Insert			4/1/2005 12:00:00 AM	8/6/2010 10:50 AM
Terminations	Termination Comments	Insert				8/6/2010 10:50 AM
Terminations	Termination Date	Insert				8/6/2010 10:50 AM
Terminations	Termination Effective Date	Insert				8/6/2010 10:50 AM
Terminations	Termination Reason	Insert				8/6/2010 10:50 AM
Details	Comments Public	Insert			6/18/09 SUITE CHANGE (WAS 200) AND ADDED MEDICAID#; 7/28/05 - NEW CONTACT	8/6/2010 10:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	6/18/2009 6:58 AM
Medicaid Billing	Medicaid: Number	Insert			13006100	6/18/2009 6:58 AM
Medicaid Billing	Medicaid: State	Insert			MD	6/18/2009 6:58 AM

340B Drug Pricing Program Database