Covered Entity Details

CH03318V BALTIMORE MEDICAL SYSTEM, INC. (Active) - information as of 4/30/2025 10:57:36 PM

Main Details

Name

BALTIMORE MEDICAL SYSTEM, INC.

Subdivision Name

Paul Laurence Dunbar High School

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013285

340B ID

CH03318V

Grant Number

H80CS00800

Additional Details

Current Program Status

Active

Registration Date

10/7/2014

Participating Start Date

1/1/2015

Participating Approval Date

10/10/2014

Last Recertification Date

2/24/2025

Contacts

Authorizing Official

Baltimore Medical System, Inc.
Shirley Sutton, Chief Executive Officer
(410) 558-4891

Primary Contact

Baltimore Medical System,Inc.
Dawn Jacobs, Director of Pharmacy Services
(443) 703-3654

Addresses

Street Address

1400 Orleans St.
Baltimore, MD 21231-1021

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	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH033180	Active	BPS-H80-036117	BALTIMORE MEDICAL SYSTEM, INC.	BMS at Yard 56	5525 Eastern Avenue	Baltimore	MD
CH03318AA	Active	BPS-H80-020992	BALTIMORE MEDICAL SYSTEM, INC.	AbsoluteCare Inc.	1040 Park Ave, Suite 200	Baltimore	MD
CH03318AB	Active	BPS-H80-030124	BALTIMORE MEDICAL SYSTEM, INC.	AbsoluteCARE of MD2, LLC	7501 Greenway Center Dr Ste 600	Greenbelt	MD
CH03318AC	Active	BPS-H80-030741	BALTIMORE MEDICAL SYSTEM, INC.	East Baltimore Medical Center	1000 E Eager St	Baltimore	MD
CH03318AD	Terminated	BPS-H80-033898	BALTIMORE MEDICAL SYSTEM, INC.	BMS at Rosedale	9520 Philadelphia Rd	Rosedale	MD
CH03318AE	Active	BPS-H80-036163	BALTIMORE MEDICAL SYSTEM, INC.	BMS at Yard 56	5525 Eastern Ave	Baltimore	MD
CH03318D	Terminated	BPS-H80-005429	BALTIMORE MEDICAL SYSTEM, INC.	BMS AT ORLEANS SQUARE	2323 Orleans St	Baltimore	MD
CH03318E	Active	BPS-H80-009361	BALTIMORE MEDICAL SYSTEM, INC.	Highlandtown Healthy Living Center	3700 Fleet St	Baltimore	MD
CH03318F	Active	BPS-H80-002655	BALTIMORE MEDICAL SYSTEM, INC.	BELAIR EDISON FAMILY HEALTH CTR	3120 Erdman Ave	Baltimore	MD
CH03318G	Active	BPS-H80-001479	BALTIMORE MEDICAL SYSTEM, INC.	TENCH TILGHMAN ELEMENTARY SCHOOL	600 N Patterson Park Ave	Baltimore	MD
CH03318J	Terminated	Unknown	BALTIMORE MEDICAL SYSTEM, INC.	Maritime Academy School Health Clinic	5001 Sinclair Ln	Baltimore	MD
CH03318K	Active	BPS-H80-001586	BALTIMORE MEDICAL SYSTEM, INC.	COLLINGTON SQUARE K-8 SCHOOL	1409 N Collington Ave	Baltimore	MD
CH03318M	Active	BPS-H80-033898	BALTIMORE MEDICAL SYSTEM, INC.	BMS at Rosedale	9520 Philadelphia Road	Rosedale	MD
CH03318Q	Active	BPS-H80-002459	BALTIMORE MEDICAL SYSTEM, INC.	BMS AT ST. AGNES	900 S. Caton Ave	Baltimore	MD
CH03318R	Active	BPS-H80-010597	BALTIMORE MEDICAL SYSTEM, INC.	Harford Heights Schools	1919 N. Broadway	Baltimore	MD
CH03318T	Active	BPS-H80-024767	BALTIMORE MEDICAL SYSTEM, INC.	Forest Park High School	3701 Eldorado Avenue	Baltimore	MD
CH03318U	Terminated	BPS-H80-009155	BALTIMORE MEDICAL SYSTEM, INC.	Dr. Rayner Browne Elementary/Middle School	1000 N Montford Ave	Baltimore	MD
CH03318V	Active	BPS-H80-013285	BALTIMORE MEDICAL SYSTEM, INC.	Paul Laurence Dunbar High School	1400 Orleans St.	Baltimore	MD
CH03318W	Active	BPS-H80-013280	BALTIMORE MEDICAL SYSTEM, INC.	Patterson Senior High School	100 Kane St.	Baltimore	MD
CH03318X	Active	BPS-H80-002816	BALTIMORE MEDICAL SYSTEM, INC.	Vanguard Collegiate Middle School	5001 Sinclair Ln	Baltimore	MD
CH03318Y	Terminated	BPS-H80-019652	BALTIMORE MEDICAL SYSTEM, INC.	BMS Pine Heights Health Center	1001 Pine Heights Ave, Suite 100	Baltimore	MD
CH03318Z	Active	BPS-H80-019574	BALTIMORE MEDICAL SYSTEM, INC.	Mergenthaler Vocational-Technical High School (Mervo)	3500 Hillen Rd	Baltimore	MD

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH033180	ABSOLUTECARE OF BALTIMORE, LLC	1040 PARK AVE STE 200		BALTIMORE	MD	21201	01/01/2017
CH033180	ABSOLUTECARE OF MD2, LLC	7501 GREENWAY CENTER DR STE 600		GREENBELT	MD	20770-6704	01/01/2020
CH033180	BALTIMORE HIGHLANDS PHARMACY	4109 ANNAPOLIS RD		BALTIMORE	MD	21227-3605	07/01/2013	06/01/2020
CH03318D	BALTIMORE HIGHLANDS PHARMACY	4109 ANNAPOLIS RD		BALTIMORE	MD	21227-3605	07/27/2010	07/01/2020
CH03318F	BALTIMORE HIGHLANDS PHARMACY	4109 ANNAPOLIS RD		BALTIMORE	MD	21227-3605	07/27/2010
CH03318E	BALTIMORE HIGHLANDS PHARMACY	4109 ANNAPOLIS RD		BALTIMORE	MD	21227-3605	07/27/2010
CH03318M	BALTIMORE HIGHLANDS PHARMACY	4109 ANNAPOLIS RD		BALTIMORE	MD	21227-3605	07/27/2010
CH03318Q	BALTIMORE HIGHLANDS PHARMACY	4109 ANNAPOLIS RD		BALTIMORE	MD	21227-3605	07/27/2010
CH033180	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2023
CH033180	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2023
CH033180	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2023
CH033180	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2023
CH033180	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2023
CH033180	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2023
CH033180	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2025
CH033180	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2025
CH033180	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2018
CH033180	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	07/01/2018	07/02/2018
CH033180	EAGER PARK PHARMACY AND HEALTH SERVICES,	DBA WALGREENS #15284	900 N. WASHINGTON STREET SUITE 1	BALTIMORE	MD	21205	07/01/2018
CH03318D	EASTERN DISCOUNT PHARMACY		163 ORVILLE ROAD	BALTIMORE	MD	21221	07/27/2010	07/01/2020
CH03318F	EASTERN DISCOUNT PHARMACY		163 ORVILLE ROAD	BALTIMORE	MD	21221	07/27/2010
CH03318E	EASTERN DISCOUNT PHARMACY		163 ORVILLE ROAD	BALTIMORE	MD	21221	07/27/2010
CH03318M	EASTERN DISCOUNT PHARMACY		163 ORVILLE ROAD	BALTIMORE	MD	21221	07/27/2010
CH03318Q	EASTERN DISCOUNT PHARMACY		163 ORVILLE ROAD	BALTIMORE	MD	21221	07/27/2010
CH033180	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	07/01/2018	07/02/2018
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04079	5603 BALTIMORE NATIONAL PIKE	BALTIMORE	MD	21228	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02522	3300 BELAIR RD.	BALTIMORE	MD	21213	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02455	2 COMPASS ROAD	BALTIMORE	MD	21220	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03974	5407-17 HARFORD RD	BALTIMORE	MD	21214	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04429	7845 WISE AVE.	BALTIMORE	MD	21222	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02045	2911 E JOPPA RD	PARKVILLE	MD	21234-3021	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02066	4625 FALLS ROAD	BALTIMORE	MD	21209	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10123	101 NORTH WOLFE ST.	BALTIMORE	MD	21231	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07656	3915 HOLLINS FERRY ROAD	BALTIMORE	MD	21227	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02865	500 EASTERN AVE.	ESSEX	MD	21221	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02160	9519 PHILADELPHIA ROAD	BALTIMORE	MD	21237	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05381	1000 S. CHARLES ST.	BALTIMORE	MD	21230	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10751	934 NORTH CHARLES ST.	BALTIMORE	MD	21201	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05764	2560 WEST FRANKLIN STREET	BALTIMORE	MD	21223	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04438	6635-37 BELAIR RD	BALTIMORE	MD	21206	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02034	5200 YORK ROAD	BALTIMORE	MD	21212	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY #10565	3200 ST. PAUL ST	BALTIMORE	MD	21218	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	CVS PHARMACY # 17663	3559 BOSTON ST	BALTIMORE	MD	21224	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04602	900 EDMONDSON AVE	BALTIMORE	MD	21228	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02334	2504 N. CHARLES STREET	BALTIMORE	MD	21218	07/01/2023	02/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10588	4701 WILKENS AVE	CATONSVILLE	MD	21228	07/01/2023
CH033180	MARYLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07952	630 EXETER ST.	BALTIMORE	MD	21202	07/01/2023
CH033180	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	07/01/2018	07/02/2018
CH033180	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2018	10/31/2022
CH033180	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2023
CH033180	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY#2733	1601 17TH STREET NW	WASHINGTON	DC	20009	07/01/2023
CH033180	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2023
CH033180	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2023
CH033180	RITE AID OF MARYLAND, INC.	RITE AID #2212	6402 GOLDEN RING ROAD	BALTIMORE	MD	21237	04/01/2020
CH033180	RITE AID OF MARYLAND, INC.	RITE AID #2204	2801 FOSTER AVENUE	BALTIMORE	MD	21224	04/01/2020
CH033180	RITE AID OF MARYLAND, INC.	RITE AID #4250	1000 EAST EAGER STREET	BALTIMORE	MD	21202	04/01/2020
CH033180	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	04/01/2020
CH033180	WAL-MART PHARMACY 10-2435	2399 NORTH POINT BLVD		DUNDALK	MD	21222	04/01/2020
CH033180	WAL-MART PHARMACY 10-3720	3601 WASHINGTON BLVD		ARBUTUS	MD	21227	04/01/2020
CH033180	WAL-MART PHARMACY 10-3804	8730 LIBERTY ROAD		RANDALLSTOWN	MD	21133	04/01/2020	04/17/2023
CH033180	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	04/01/2020
CH033180	WALGREEN CO	DBA: WALGREENS #7678	1260 LIBERTY RD	ELDERSBURG	MD	21784-7928	04/01/2013
CH033180	WALGREEN CO	DBA: WALGREENS #10076	2560 QUARRY LAKE DR	BALTIMORE	MD	21209	04/01/2013
CH033180	WALGREEN CO	DBA: WALGREENS #10539	12400 AUTO DRIVE	CLARKSVILLE	MD	21029	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 02446	6 SOUTH MARLYN AVE	ESSEX	MD	21221	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 05331	8050 LIBERTY ROAD	BALTIMORE	MD	21244	04/01/2013	11/06/2023
CH033180	WALGREEN CO.	DBA: WALGREENS # 05408	1300 EAST NORTH AVE	BALTIMORE	MD	21213-1406	04/01/2013	11/13/2024
CH033180	WALGREEN CO.	DBA: WALGREENS # 05409	4020 EASTERN AVENUE	BALTIMORE	MD	21224	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 05410	19 E FAYETTE ST STE 100	BALTIMORE	MD	21202	04/01/2013	11/06/2024
CH033180	WALGREEN CO.	DBA: WALGREENS # 05587	9621 BELAIR RD	BALTIMORE	MD	21236	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 05623	3801 LIBERTY HEIGHTS AVE	BALTIMORE	MD	21215	04/01/2013	01/23/2025
CH033180	WALGREEN CO.	DBA: WALGREENS # 05638	4025 W NORTHERN PKWY	BALTIMORE	MD	21215	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 05686	401 COMPASS RD E	BALTIMORE	MD	21220	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS #06007	5740 RITCHIE HWY	BROOKLYN	MD	21225	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 06265	9110 LIBERTY ROAD	RANDALLSTOWN	MD	21133	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 06320	2204 N ROLLING ROAD	BALTIMORE	MD	21244	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 21331	2001 W PATAPSCO AVE	BALTIMORE	MD	21230	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 06396	8606 PHILADELPHIA RD	ROSEDALE	MD	21237	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 06779	9616 HARFORD ROAD	BALTIMORE	MD	21234-2104	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 07357	3005 EMMORTON ROAD	ABINGDON	MD	21009	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 07554	7901 RITCHIE HIGHWAY	GLEN BURNIE	MD	21061	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 07573	6301 YORK ROAD	BALTIMORE	MD	21212-2636	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 07574	5657 BALTIMORE NATIONAL PIKE	CATONSVILLE	MD	21228-1412	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 07701	7953 CRAIN HWY S.	GLEN BURNIE	MD	21061	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS # 09028	6700 RITCHIE HWY	GLEN BURNIE	MD	21061-2319	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS #11501	496 RITCHIE HWY	SEVERNA PARK	MD	21146	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS #12790	6323 BALTIMORE NATIONAL PIKE	CATONSVILLE	MD	21228	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS #12847	1801 YORK RD	LUTHERVILLE	MD	21093	04/01/2013
CH033180	WALGREEN CO.	DBA: WALGREENS #11949	5585 TWIN KNOLLS RD	COLUMBIA	MD	21045	07/01/2013
CH033180	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15308	6 N HOWARD STREET	BALTIMORE	MD	21201	10/01/2014
CH033180	WALGREEN CO.	DBA: WALGREENS #16188	2000 W. BALTIMORE STREET	BALTIMORE	MD	21223	10/01/2014
CH033180	WALGREEN CO.	DBA: WALGREENS #16190	301 SAINT PAUL ST	BALTIMORE	MD	21202	10/01/2014
CH033180	WALGREEN CO.	DBA: WALGREENS #16191	2411 W. BELVEDERE AVENUE SUITE 101	BALTIMORE	MD	21215	10/01/2014
CH033180	WALGREEN CO.	DBA: WALGREENS #16199	900 S. CATON AVENUE	BALTIMORE	MD	21229	10/01/2014	10/14/2019
CH033180	WALGREEN CO.	WALGREENS #19115	140 BACK RIVER NECK RD	BALTIMORE	MD	21221-3924	04/01/2019
CH033180	WALGREEN CO.	WALGREENS #19149	6 CARROLL ISLAND RD	BALTIMORE	MD	21220	04/01/2019	01/30/2025
CH033180	WALGREEN CO.	WALGREENS #19086	7535 HOLABIRD AVE	BALTIMORE	MD	21222-2105	04/01/2019
CH033180	WALGREEN CO.	WALGREENS #17889	3935 ERDMAN AVE # 37	BALTIMORE	MD	21213-2004	04/01/2019	02/21/2023
CH033180	WALGREEN CO.	WALGREENS #18155	4214 FRANKFORD AVE	BALTIMORE	MD	21206-5131	04/01/2019	01/22/2025
CH033180	WALGREEN CO.	WALGREENS #19149	6 CARROLL ISLAND RD	BALTIMORE	MD	21220	04/01/2019
CH033180	WALGREEN CO.	WALGREENS #18015	4733 WESTLAND BLVD STE 21	ARBUTUS	MD	21227	04/01/2019
CH033180	WALGREEN CO.	WALGREENS #17300	29 SHIPPING PL # 31	BALTIMORE	MD	21222-4318	04/01/2019	05/04/2023
CH033180	WALGREEN CO.	COMMUNITY, A WALGREENS PHARMACY #21166	1114 CATHEDRAL ST. SUITE 3	BALTIMORE	MD	21201	04/01/2019
CH033180	WALGREEN CO.	RITE AID #01792	5618 THE ALAMEDA	BALTIMORE	MD	21239	04/01/2019	05/03/2019
CH033180	WALGREEN CO.	WALGREENS #17609	300 MARTIN LUTHER KING JR BLVD	BALTIMORE	MD	21201	07/01/2020	11/16/2023
CH033180	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	07/22/2015
CH033180	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	07/22/2015
CH033180	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2018
CH033180	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2018
CH033180	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2018	12/30/2022
CH033180	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2018
CH033180	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/01/2023
CH033180	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/23/2024 9:22:42 AM	2/24/2025 2:32:52 PM	2/24/2025 2:32 PM
Details	Last Recertification Date	Update	Recertification	2/16/2023 4:37:27 PM	2/23/2024 9:22:42 AM	2/23/2024 9:22 AM
Details	Last Recertification Date	Update	Recertification	2/17/2022 3:19:21 PM	2/16/2023 4:37:27 PM	2/16/2023 4:37 PM
Details	Last Recertification Date	Update	Recertification	2/3/2021 1:31:18 PM	2/17/2022 3:19:21 PM	2/17/2022 3:19 PM
Details	Last Recertification Date	Update	Recertification	2/14/2020 9:30:22 AM	2/3/2021 1:31:18 PM	2/3/2021 1:31 PM
Details	Last Recertification Date	Update	Recertification	1/29/2019 9:07:51 AM	2/14/2020 9:30:22 AM	2/14/2020 9:30 AM
Contacts	Authorizing Official	Update	Change Request	Reuther, Donald Chief Operating Officer Baltimore Medical System, Inc. 4437033468	Sutton, Shirley Chief Executive Officer Baltimore Medical System, Inc. 4105584891	11/26/2019 1:47 PM
Details	Is Authorizing Official EHB Data	Update	Change Request	False		11/26/2019 1:47 PM
Details	Last Recertification Date	Update	Recertification	2/13/2018 9:11:12 AM	1/29/2019 9:07:51 AM	1/29/2019 9:07 AM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/13/2018 9:11:12 AM	2/13/2018 9:11 AM
Contacts	Authorizing Official	Update	Profile Change Request	Sutton, Shirley Chief Executive Officer Baltimore Medical System, Inc. 4105584891	Reuther, Donald Chief Operating Officer Baltimore Medical System, Inc. 4437033468	11/8/2017 1:53 PM
Contacts	Authorizing Official	Update	Change Request	Reuther, Donald Chief Operating Officer Baltimore Medical System 4437033468	Sutton, Shirley Chief Executive Officer Baltimore Medical System, Inc. 4105584891	11/7/2017 11:06 AM
Contacts	Authorizing Official	Update		Reuther, Donald Chief Operating Officer 4437033468	Reuther, Donald Chief Operating Officer Baltimore Medical System 4437033468	11/7/2017 11:03 AM
Contacts	Primary Contact	Update		Jacobs, Dawn Director of Pharmacy Services 4437033654	Jacobs, Dawn Director of Pharmacy Services Baltimore Medical System,Inc. 4437033654	10/9/2017 4:05 PM
Contacts	Primary Contact	Insert			Jacobs, Dawn Director of Pharmacy Services 4437033654	7/13/2017 2:50 PM
Contacts	Authorizing Official	Insert			Reuther, Donald Chief Operating Officer 4437033468	2/1/2017 8:47 AM
Contacts	Signed By	Insert			Gleichauf, Paul President and CEO 4105584891	2/1/2017 8:47 AM
Addresses	Main Address	Insert			1400 Orleans St. Baltimore, MD 21231-1021	2/1/2017 8:47 AM
Details	Last Recertification Date	Update		2/23/2016 12:00:00 AM	2/1/2017 12:00:00 AM	2/1/2017 8:47 AM
Details	Last Recertification Date	Update		3/3/2015 12:00:00 AM	2/23/2016 12:00:00 AM	2/23/2016 1:59 PM
Details	Last Recertification Date	Update			3/3/2015 12:00:00 AM	3/3/2015 9:31 AM
Dates	Participating Approval Date	Update			10/10/2014 12:00:00 AM	10/10/2014 12:22 PM
Details	State	Update		Pending	Active	10/10/2014 12:22 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	10/10/2014 12:22 PM
Details	340B ID	Update		ONLINE_REG_46646	CH03318V	10/8/2014 9:43 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_46646	10/7/2014 1:38 PM
Details	Last Recertification Date	Insert				10/7/2014 1:38 PM
Details	Grant Number	Insert			H80CS00800	10/7/2014 1:38 PM
Details	340B ID	Insert			ONLINE_REG	10/7/2014 1:38 PM
Details	Is Authorizing Official EHB Data	Insert			False	10/7/2014 1:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/7/2014 1:38 PM
Details	Medicare Provider Number	Insert				10/7/2014 1:38 PM
Details	Entity Name	Insert			BALTIMORE MEDICAL SYSTEM, INC.	10/7/2014 1:38 PM
Details	Program Code	Insert			CH	10/7/2014 1:38 PM
Details	Entity Subname	Insert			Paul Laurence Dunbar High School	10/7/2014 1:38 PM
Dates	Participating Approval Date	Insert				10/7/2014 1:38 PM
Details	State	Insert			Pending	10/7/2014 1:38 PM
Dates	Registration Date	Insert			10/7/2014 12:00:00 AM	10/7/2014 1:38 PM
Dates	Signed By Date	Insert			10/7/2014 12:00:00 AM	10/7/2014 1:38 PM
Dates	Start Date	Insert				10/7/2014 1:38 PM
Terminations	Termination Comments	Insert				10/7/2014 1:38 PM
Terminations	Termination Date	Insert				10/7/2014 1:38 PM
Terminations	Termination Effective Date	Insert				10/7/2014 1:38 PM
Terminations	Termination Reason	Insert				10/7/2014 1:38 PM

340B Drug Pricing Program Database