Covered Entity Details

CHC06642-00 WESTERN MARYLAND HEALTH CARE CORPORATION (Active) - information as of 5/9/2025 10:50:14 PM

Main Details

Name

WESTERN MARYLAND HEALTH CARE CORPORATION

Subdivision Name

Mountain Laurel Medical Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-009507

340B ID

CHC06642-00

Grant Number

H80CS06642

Additional Details

Current Program Status

Active

Registration Date

1/8/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/19/2013

Last Recertification Date

2/10/2025

Contacts

Authorizing Official

Western Maryland Healthcare Corporation
James W. Mou, CFO
(301) 533-3300 Ext: 3018

Primary Contact

Western Maryland Healthcare Corporation
Jennifer Lowdermilk, Senior Accountant/340B Specialist
(301) 533-3300 Ext: 3096

Addresses

Street Address

1027 Memorial Dr
Oakland, MD 21550-4343

Billing Address
Same as Street Address

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

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

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	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	04/07/2017	07/01/2017	05/08/2017	05/08/2017
Contract Detail	BEDFORD ROAD PHARMACY, INC. DBA	THE MEDICINE SHOPPE OF GRANTSVILLE	149 MAIN ST	GRANTSVILLE	MD	21536	07/03/2018	10/01/2018	07/30/2020	07/31/2020
Contract Detail	BEDFORD ROAD PHARMACY, INC. DBA	THE MEDICINE SHOPPE OF GEORGES CREEK	19 MAIN ST	LONACONING	MD	21539-1122	10/23/2019	01/01/2020	10/27/2023	10/27/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/10/2023	01/01/2024		01/01/2024
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/10/2023	01/01/2024		01/01/2024
Contract Detail	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	04/07/2017	07/01/2017	05/08/2017	05/08/2017
Contract Detail	GREGG'S PHARMACY WV, INC.	101 GREGG MEMORIAL DR		TERRA ALTA	WV	26764-1071	07/11/2018	10/01/2018	07/13/2018	07/13/2018
Contract Detail	GREGG'S PHARMACY WV, INC.	101 GREGG MEMORIAL DR		TERRA ALTA	WV	26764-1071	01/14/2020	04/01/2020	09/16/2022	09/16/2022
Contract Detail	GREGGS PHARMACY INC	20 N 3RD ST		OAKLAND	MD	21550-1322	07/11/2018	10/01/2018		10/01/2018
Contract Detail	HIGHLAND PHARMACY AND WELLNESS	198 MORGANTOWN ST STE 1		BRUCETON MILLS	WV	26525-5003	07/18/2023	10/01/2023		10/01/2023
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04102	220 NORTH 3RD ST.	OAKLAND	MD	21550	01/15/2020	04/01/2020		04/01/2020
Contract Detail	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05728	1202 NATIONAL HWY	LA VALE	MD	21502	01/15/2020	04/01/2020		04/01/2020
Contract Detail	MOUNTAIN LAUREL COMMUNITY PHARMACY	1027 MEMORIAL DRIVE	SUITE 100	OAKLAND	MD	21550	12/17/2015	01/01/2016		12/17/2015
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/12/2023	01/01/2024		01/01/2024
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/12/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY #10-2474	R.R. #4 BOX 82		KEYSER	WV	26726	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-2027	12500 COUNTRY CLUB MALL RD SW		LAVALE	MD	21502	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-2083	75 RETAIL CIRCLE		MORGANTOWN	WV	26508	01/09/2025	04/01/2025		04/01/2025
Contract Detail	WAL-MART PHARMACY 10-2833	1 WAL-MART LANE		GRAFTON	WV	26354	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-2894	13164 GARRETT HIGHWAY		OAKLAND	MD	21550	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-4372	100 WAL-MART DRIVE		KINGWOOD	WV	26537	10/05/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/18/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12266	209 N 3RD ST	OAKLAND	MD	21550	10/05/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #17679	3237 CHESTNUT RIDGE RD	GRANTSVILLE	MD	21536	10/05/2020	01/01/2021		01/01/2021
Contract Detail	WALGREEN CO.	WALGREENS #17857	101 BISHOP MURPHY DR	FROSTBURG	MD	21532	04/04/2023	07/01/2023		07/01/2023
Contract Detail	WALGREEN CO.	WALGREENS #19956	839 S MINERAL ST	KEYSER	WV	26726	04/04/2023	07/01/2023	02/21/2023	07/25/2023
Contract Detail	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	10/09/2023	01/01/2024		01/01/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/07/2023	07/01/2023		07/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/05/2023	01/01/2024		01/01/2024
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01427	45 S. MINERAL ST.	KEYSER	WV	26726	01/15/2020	04/01/2020		04/01/2020
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04166	743 N MAIN ST	MOOREFIELD	WV	26836	01/15/2020	04/01/2020	02/09/2022	02/17/2022

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CHC06642-00	Active	BPS-H80-009507	WESTERN MARYLAND HEALTH CARE CORPORATION	Mountain Laurel Medical Center	1027 Memorial Dr	Oakland	MD
CHC06642-01	Active	BPS-H80-014092	WESTERN MARYLAND HEALTH CARE CORPORATION	Mountain Laurel Medical Center Grantsville	104 PARKVIEW DR	GRANTSVILLE	MD
CHC06642-02	Active	BPS-H80-027833	Western Maryland Health Care Corporation	Mountain Laurel Medical Center Westernport	22221 Westernport Rd SW	Westernport	MD
CHC06642-03	Active	BPS-H80-036562	WESTERN MARYLAND HEALTH CARE CORPORATION	Mountain Laurel Medical Center Bruceton Mills	198 Morgantown St	Bruceton Mills	WV
CHC06642-04	Active	BPS-H80-039083	WESTERN MARYLAND HEALTH CARE CORPORATION	Mountain Laurel Medical Center Grantsville	28 Hershberger Ln	Grantsville	MD

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CHC06642-00	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	07/01/2017	05/08/2017
CHC06642-03	AHSSHC	EXPEDIEN RX PHARMACY	5050 WESLEY RD STE 120	APOPKA	FL	32712	01/01/2024
CHC06642-00	BEDFORD ROAD PHARMACY, INC. DBA	THE MEDICINE SHOPPE OF GRANTSVILLE	149 MAIN ST	GRANTSVILLE	MD	21536	10/01/2018	07/30/2020
CHC06642-02	BEDFORD ROAD PHARMACY, INC. DBA	THE MEDICINE SHOPPE OF GEORGES CREEK	19 MAIN ST	LONACONING	MD	21539-1122	01/01/2020	10/27/2023
CHC06642-01	BEDFORD ROAD PHARMACY, INC. DBA	THE MEDICINE SHOPPE OF GEORGES CREEK	19 MAIN ST	LONACONING	MD	21539-1122	01/01/2020	10/27/2023
CHC06642-00	BEDFORD ROAD PHARMACY, INC. DBA	THE MEDICINE SHOPPE OF GEORGES CREEK	19 MAIN ST	LONACONING	MD	21539-1122	01/01/2020	10/27/2023
CHC06642-03	BEDFORD ROAD PHARMACY, INC. DBA	THE MEDICINE SHOPPE OF GEORGES CREEK	19 MAIN ST	LONACONING	MD	21539-1122	01/01/2024	10/27/2023
CHC06642-02	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CHC06642-01	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CHC06642-00	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CHC06642-03	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CHC06642-01	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CHC06642-02	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CHC06642-03	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CHC06642-00	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CHC06642-00	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2017	05/08/2017
CHC06642-00	GREGG'S PHARMACY WV, INC.	101 GREGG MEMORIAL DR		TERRA ALTA	WV	26764-1071	10/01/2018	07/13/2018
CHC06642-02	GREGG'S PHARMACY WV, INC.	101 GREGG MEMORIAL DR		TERRA ALTA	WV	26764-1071	04/01/2020	09/16/2022
CHC06642-00	GREGG'S PHARMACY WV, INC.	101 GREGG MEMORIAL DR		TERRA ALTA	WV	26764-1071	04/01/2020	09/16/2022
CHC06642-00	GREGGS PHARMACY INC	20 N 3RD ST		OAKLAND	MD	21550-1322	10/01/2018
CHC06642-02	GREGGS PHARMACY INC	20 N 3RD ST		OAKLAND	MD	21550-1322	10/01/2023
CHC06642-01	GREGGS PHARMACY INC	20 N 3RD ST		OAKLAND	MD	21550-1322	10/01/2023
CHC06642-03	GREGGS PHARMACY INC	20 N 3RD ST		OAKLAND	MD	21550-1322	01/01/2024
CHC06642-01	HIGHLAND PHARMACY AND WELLNESS	198 MORGANTOWN ST STE 1		BRUCETON MILLS	WV	26525-5003	10/01/2023
CHC06642-02	HIGHLAND PHARMACY AND WELLNESS	198 MORGANTOWN ST STE 1		BRUCETON MILLS	WV	26525-5003	10/01/2023
CHC06642-00	HIGHLAND PHARMACY AND WELLNESS	198 MORGANTOWN ST STE 1		BRUCETON MILLS	WV	26525-5003	10/01/2023
CHC06642-03	HIGHLAND PHARMACY AND WELLNESS	198 MORGANTOWN ST STE 1		BRUCETON MILLS	WV	26525-5003	01/01/2024
CHC06642-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04102	220 NORTH 3RD ST.	OAKLAND	MD	21550	04/01/2020
CHC06642-00	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05728	1202 NATIONAL HWY	LA VALE	MD	21502	04/01/2020
CHC06642-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05728	1202 NATIONAL HWY	LA VALE	MD	21502	10/01/2023
CHC06642-01	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04102	220 NORTH 3RD ST.	OAKLAND	MD	21550	10/01/2023
CHC06642-01	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05728	1202 NATIONAL HWY	LA VALE	MD	21502	10/01/2023
CHC06642-02	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04102	220 NORTH 3RD ST.	OAKLAND	MD	21550	10/01/2023
CHC06642-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04102	220 NORTH 3RD ST.	OAKLAND	MD	21550	01/01/2024
CHC06642-03	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05728	1202 NATIONAL HWY	LA VALE	MD	21502	01/01/2024
CHC06642-00	MOUNTAIN LAUREL COMMUNITY PHARMACY	1027 MEMORIAL DRIVE	SUITE 100	OAKLAND	MD	21550	01/01/2016
CHC06642-01	MOUNTAIN LAUREL COMMUNITY PHARMACY	1027 MEMORIAL DRIVE	SUITE 100	OAKLAND	MD	21550	10/01/2023
CHC06642-02	MOUNTAIN LAUREL COMMUNITY PHARMACY	1027 MEMORIAL DRIVE	SUITE 100	OAKLAND	MD	21550	10/01/2023
CHC06642-03	MOUNTAIN LAUREL COMMUNITY PHARMACY	1027 MEMORIAL DRIVE	SUITE 100	OAKLAND	MD	21550	01/01/2024
CHC06642-02	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	01/01/2024
CHC06642-03	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	01/01/2024
CHC06642-01	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	01/01/2024
CHC06642-00	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	01/01/2024
CHC06642-03	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
CHC06642-03	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2024
CHC06642-02	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
CHC06642-02	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2024
CHC06642-00	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2024
CHC06642-01	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
CHC06642-01	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	01/01/2024
CHC06642-00	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2024
CHC06642-01	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
CHC06642-03	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
CHC06642-00	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
CHC06642-02	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	01/01/2024
CHC06642-00	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CHC06642-03	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/01/2024
CHC06642-00	WAL-MART PHARMACY #10-2474	R.R. #4 BOX 82		KEYSER	WV	26726	10/01/2017
CHC06642-02	WAL-MART PHARMACY #10-2474	R.R. #4 BOX 82		KEYSER	WV	26726	10/01/2023
CHC06642-01	WAL-MART PHARMACY #10-2474	R.R. #4 BOX 82		KEYSER	WV	26726	10/01/2023
CHC06642-03	WAL-MART PHARMACY #10-2474	R.R. #4 BOX 82		KEYSER	WV	26726	01/01/2024
CHC06642-00	WAL-MART PHARMACY 10-2027	12500 COUNTRY CLUB MALL RD SW		LAVALE	MD	21502	10/01/2017
CHC06642-01	WAL-MART PHARMACY 10-2027	12500 COUNTRY CLUB MALL RD SW		LAVALE	MD	21502	10/01/2023
CHC06642-02	WAL-MART PHARMACY 10-2027	12500 COUNTRY CLUB MALL RD SW		LAVALE	MD	21502	10/01/2023
CHC06642-03	WAL-MART PHARMACY 10-2027	12500 COUNTRY CLUB MALL RD SW		LAVALE	MD	21502	01/01/2024
CHC06642-02	WAL-MART PHARMACY 10-2083	75 RETAIL CIRCLE		MORGANTOWN	WV	26508	04/01/2025
CHC06642-00	WAL-MART PHARMACY 10-2083	75 RETAIL CIRCLE		MORGANTOWN	WV	26508	04/01/2025
CHC06642-03	WAL-MART PHARMACY 10-2083	75 RETAIL CIRCLE		MORGANTOWN	WV	26508	04/01/2025
CHC06642-01	WAL-MART PHARMACY 10-2083	75 RETAIL CIRCLE		MORGANTOWN	WV	26508	04/01/2025
CHC06642-00	WAL-MART PHARMACY 10-2833	1 WAL-MART LANE		GRAFTON	WV	26354	10/01/2017
CHC06642-02	WAL-MART PHARMACY 10-2833	1 WAL-MART LANE		GRAFTON	WV	26354	10/01/2023
CHC06642-01	WAL-MART PHARMACY 10-2833	1 WAL-MART LANE		GRAFTON	WV	26354	10/01/2023
CHC06642-03	WAL-MART PHARMACY 10-2833	1 WAL-MART LANE		GRAFTON	WV	26354	01/01/2024
CHC06642-00	WAL-MART PHARMACY 10-2894	13164 GARRETT HIGHWAY		OAKLAND	MD	21550	10/01/2017
CHC06642-01	WAL-MART PHARMACY 10-2894	13164 GARRETT HIGHWAY		OAKLAND	MD	21550	10/01/2023
CHC06642-02	WAL-MART PHARMACY 10-2894	13164 GARRETT HIGHWAY		OAKLAND	MD	21550	10/01/2023
CHC06642-03	WAL-MART PHARMACY 10-2894	13164 GARRETT HIGHWAY		OAKLAND	MD	21550	01/01/2024
CHC06642-00	WAL-MART PHARMACY 10-4372	100 WAL-MART DRIVE		KINGWOOD	WV	26537	01/01/2024
CHC06642-01	WAL-MART PHARMACY 10-4372	100 WAL-MART DRIVE		KINGWOOD	WV	26537	01/01/2024
CHC06642-02	WAL-MART PHARMACY 10-4372	100 WAL-MART DRIVE		KINGWOOD	WV	26537	01/01/2024
CHC06642-03	WAL-MART PHARMACY 10-4372	100 WAL-MART DRIVE		KINGWOOD	WV	26537	01/01/2024
CHC06642-00	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CHC06642-03	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/01/2024
CHC06642-00	WALGREEN CO.	DBA: WALGREENS #12266	209 N 3RD ST	OAKLAND	MD	21550	01/01/2021
CHC06642-00	WALGREEN CO.	WALGREENS #17679	3237 CHESTNUT RIDGE RD	GRANTSVILLE	MD	21536	01/01/2021
CHC06642-01	WALGREEN CO.	DBA: WALGREENS #12266	209 N 3RD ST	OAKLAND	MD	21550	01/01/2021
CHC06642-01	WALGREEN CO.	WALGREENS #17679	3237 CHESTNUT RIDGE RD	GRANTSVILLE	MD	21536	01/01/2021
CHC06642-02	WALGREEN CO.	WALGREENS #17857	101 BISHOP MURPHY DR	FROSTBURG	MD	21532	04/01/2023
CHC06642-02	WALGREEN CO.	WALGREENS #19956	839 S MINERAL ST	KEYSER	WV	26726	04/01/2023	02/21/2023
CHC06642-00	WALGREEN CO.	WALGREENS #17857	101 BISHOP MURPHY DR	FROSTBURG	MD	21532	07/01/2023
CHC06642-00	WALGREEN CO.	WALGREENS #19956	839 S MINERAL ST	KEYSER	WV	26726	07/01/2023	02/21/2023
CHC06642-01	WALGREEN CO.	WALGREENS #17857	101 BISHOP MURPHY DR	FROSTBURG	MD	21532	07/01/2023
CHC06642-01	WALGREEN CO.	WALGREENS #19956	839 S MINERAL ST	KEYSER	WV	26726	07/01/2023	02/21/2023
CHC06642-02	WALGREEN CO.	DBA: WALGREENS #12266	209 N 3RD ST	OAKLAND	MD	21550	10/01/2023
CHC06642-02	WALGREEN CO.	WALGREENS #17679	3237 CHESTNUT RIDGE RD	GRANTSVILLE	MD	21536	10/01/2023
CHC06642-03	WALGREEN CO.	WALGREENS #17857	101 BISHOP MURPHY DR	FROSTBURG	MD	21532	01/01/2024
CHC06642-03	WALGREEN CO.	DBA: WALGREENS #12266	209 N 3RD ST	OAKLAND	MD	21550	01/01/2024
CHC06642-03	WALGREEN CO.	WALGREENS #17679	3237 CHESTNUT RIDGE RD	GRANTSVILLE	MD	21536	01/01/2024
CHC06642-02	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CHC06642-01	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CHC06642-00	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CHC06642-03	Walgreens #21423	Walgreens Central Fill #21423	6275 Winchester Blvd	Canal WInchester	OH	43110-6537	01/01/2024
CHC06642-00	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CHC06642-02	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CHC06642-01	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CHC06642-03	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CHC06642-01	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC06642-03	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC06642-02	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC06642-00	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024
CHC06642-00	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01427	45 S. MINERAL ST.	KEYSER	WV	26726	04/01/2020
CHC06642-00	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04166	743 N MAIN ST	MOOREFIELD	WV	26836	04/01/2020	02/09/2022
CHC06642-02	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01427	45 S. MINERAL ST.	KEYSER	WV	26726	10/01/2023
CHC06642-01	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01427	45 S. MINERAL ST.	KEYSER	WV	26726	10/01/2023
CHC06642-03	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01427	45 S. MINERAL ST.	KEYSER	WV	26726	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/30/2024 1:46:32 PM	2/10/2025 9:46:55 AM	2/10/2025 9:46 AM
Details	Last Recertification Date	Update	Recertification	2/6/2023 12:24:32 PM	1/30/2024 1:46:32 PM	1/30/2024 1:46 PM
Contacts	Authorizing Official	Update	Change Request	BAILEY, BRIAN CEO WESTERN MARYLAND HEALTH CARE CORP 3015333300-3056	Mou, James W. CFO Western Maryland Healthcare Corporation 3015333300-3018	9/5/2023 2:31 PM
Contacts	Authorizing Official	Update	Change Request	Pierce, Drew Chief Financial Officer Western Maryland Health Care Corporation 3015333300-3018	BAILEY, BRIAN CEO WESTERN MARYLAND HEALTH CARE CORP 3015333300-3056	5/30/2023 9:34 AM
Contacts	Authorizing Official	Update	Change Request	BAILEY, BRIAN CEO WESTERN MARYLAND HEALTH CARE CORP 3015333300-3056	Pierce, Drew Chief Financial Officer Western Maryland Health Care Corporation 3015333300-3018	2/14/2023 4:48 PM
Details	Last Recertification Date	Update	Recertification	2/2/2022 8:48:33 AM	2/6/2023 12:24:32 PM	2/6/2023 12:24 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 8:57:31 AM	2/2/2022 8:48:33 AM	2/2/2022 8:48 AM
Contacts	Authorizing Official	Update	Change Request	Wilson, Jeremy CFO Western Maryland Health Care Corp 3015333300-3018	BAILEY, BRIAN CEO WESTERN MARYLAND HEALTH CARE CORP 3015333300-3056	4/23/2021 10:36 AM
Contacts	Primary Contact	Update	Recertification	Moore, Sandra COO Mountain Laurel Medical Center 3015333300	Lowdermilk, Jennifer Senior Accountant/340B Specialist Western Maryland Healthcare Corporation 3015333300-3096	2/5/2021 8:57 AM
Details	Last Recertification Date	Update	Recertification	1/28/2020 7:14:00 AM	2/5/2021 8:57:31 AM	2/5/2021 8:57 AM
Details	Last Recertification Date	Update	Recertification	1/30/2019 10:31:55 AM	1/28/2020 7:14:00 AM	1/28/2020 7:14 AM
Contacts	Authorizing Official	Update	Change Request	Wilt, Charles Lee CEO Western Maryland Health Care Corp 3015333300-3056	Wilson, Jeremy CFO Western Maryland Health Care Corp 3015333300-3018	10/21/2019 10:26 AM
Contacts	Primary Contact	Update	Change Request	Wilson, Jeremy CFO Western Maryland Health Care Corp 3015333300-3018	Moore, Sandra COO Mountain Laurel Medical Center 3015333300	10/21/2019 10:26 AM
Details	Last Recertification Date	Update	Recertification	2/7/2018 10:54:45 AM	1/30/2019 10:31:55 AM	1/30/2019 10:31 AM
Details	Last Recertification Date	Update	Recertification	1/25/2017 12:00:00 AM	2/7/2018 10:54:45 AM	2/7/2018 10:54 AM
Contacts	Primary Contact	Update	Recertification	Wilson, Jeremy CFO 3015333300-3018	Wilson, Jeremy CFO Western Maryland Health Care Corp 3015333300-3018	2/7/2018 10:53 AM
Contacts	Authorizing Official	Update		Wilt, Charles CEO 3015333300-3056	Wilt, Charles Lee CEO Western Maryland Health Care Corp 3015333300-3056	9/19/2017 3:45 PM
Contacts	Authorizing Official	Insert			Wilt, Charles CEO 3015333300-3056	7/18/2017 2:30 PM
Addresses	Main Address	Insert			1027 Memorial Dr Oakland, MD 21550-4343	7/18/2017 11:30 AM
Contacts	Primary Contact	Insert			Wilson, Jeremy CFO 3015333300-3018	7/18/2017 11:30 AM
Contacts	Signed By	Insert			Little-Terry, Beth CEO 3015333300-3019	7/18/2017 11:30 AM
Details	Last Recertification Date	Update		3/1/2016 12:00:00 AM	1/25/2017 12:00:00 AM	1/25/2017 11:45 AM
Details	Last Recertification Date	Update		3/2/2015 12:00:00 AM	3/1/2016 12:00:00 AM	3/1/2016 10:01 AM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	3/2/2015 12:00:00 AM	3/2/2015 9:39 AM
Details	Entity Name	Update		Western Maryland Healthcare Corporation	WESTERN MARYLAND HEALTH CARE CORPORATION	3/31/2014 4:25 PM
Details	Last Recertification Date	Update			2/10/2014 12:00:00 AM	2/10/2014 8:40 AM
Details	340B ID	Update		IS-FN-CHC-06642	CHC06642-00	2/19/2013 2:35 PM
Details	Medicare Provider Number	Update		211854		2/19/2013 2:35 PM
Dates	Participating Approval Date	Update			2/19/2013 12:00:00 AM	2/19/2013 2:35 PM
Details	State	Update		Pending	Active	2/19/2013 2:35 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/19/2013 2:35 PM
Details	Grant Number	Update		H80CS06642-08-00	H80CS06642	1/31/2013 4:36 PM
Details	340B ID	Update		ONLINE_REG	IS-FN-CHC-06642	1/31/2013 4:36 PM
Details	Last Recertification Date	Insert				1/8/2013 12:09 PM
Details	Grant Number	Insert			H80CS06642-08-00	1/8/2013 12:09 PM
Details	340B ID	Insert			ONLINE_REG	1/8/2013 12:09 PM
Details	Is Authorizing Official EHB Data	Insert				1/8/2013 12:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2013 12:09 PM
Details	Medicare Provider Number	Insert			211854	1/8/2013 12:09 PM
Details	Entity Name	Insert			Western Maryland Healthcare Corporation	1/8/2013 12:09 PM
Details	Program Code	Insert			CH	1/8/2013 12:09 PM
Details	Entity Subname	Insert			Mountain Laurel Medical Center	1/8/2013 12:09 PM
Dates	Participating Approval Date	Insert				1/8/2013 12:09 PM
Details	State	Insert			Pending	1/8/2013 12:09 PM
Dates	Registration Date	Insert			1/8/2013 12:00:00 AM	1/8/2013 12:09 PM
Dates	Signed By Date	Insert			1/8/2013 12:00:00 AM	1/8/2013 12:09 PM
Dates	Start Date	Insert				1/8/2013 12:09 PM
Terminations	Termination Comments	Insert				1/8/2013 12:09 PM
Terminations	Termination Date	Insert				1/8/2013 12:09 PM
Terminations	Termination Effective Date	Insert				1/8/2013 12:09 PM
Terminations	Termination Reason	Insert				1/8/2013 12:09 PM

340B Drug Pricing Program Database