340B Drug Pricing Program Database


CH03664G CHASE BREXTON HEALTH SERVICES, INC (Active) - information as of 6/8/2025 11:58:04 PM

Main Details
CHASE BREXTON HEALTH SERVICES, INC
Chase Brexton Health Care Anne Arundel Center
HRSA-Funded Health Center
BPS-H80-014468
CH03664G
H80CS00734


Additional Details
Active
10/8/2014
1/1/2015
10/16/2014
2/10/2025

Contacts

Chase Brexton Health Care
Eric Turnbaugh, CFO
(410) 837-2050 Ext: 1148

Chase Brexton Health Care
Jeffrey Allen Cywinski, Director of Pharmacy
(410) 837-2050 Ext: 1115

Addresses

200 Hospital Dr
GLEN BURNIE, MD 21061-3961

Chase Brexton Health Services, Inc
1111 N. Charles Street
Baltimore, MD 21201


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MD 1912458381,1497161483,1184722175,1578699575,1598036618,1982118444
Shipping Addresses

Chase Brexton Health Care
200 Hospital Dr #500
Glen Burnie, MD 21061-3961
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/25/201710/01/2017  10/01/2017
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/18/201704/01/2017  01/18/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/25/201710/01/2017  10/01/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/25/201710/01/2017  10/01/2017
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/25/201710/01/2017  10/01/2017
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/25/201710/01/2017  10/01/2017
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/18/201704/01/2017  01/18/2017
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813307/25/201710/01/2017  10/01/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/25/201710/01/2017  10/01/2017
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/18/201704/01/2017  01/18/2017
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH036640ActiveBPS-H80-011410CHASE BREXTON HEALTH SERVICES, INCChase Brexton Health Services, Inc.1111 North Charles Street BaltimoreMD
CH03664ABActiveBPS-H80-005298CHASE BREXTON HEALTH SERVICES, INCCHASE BREXTON HEALTH SERVICES5500 Knoll North Dr STE 370 ColumbiaMD
CH03664CActiveBPS-H80-037862CHASE BREXTON HEALTH SERVICES, INCChase Brexton Health Services, Inc. at Security Square Center6901 Security Blvd Windsor MillMD
CH03664DActiveBPS-H80-030404CHASE BREXTON HEALTH SERVICES, INCChase Brexton Health Services, Inc.500 Cadmus Ln Ste 203 EastonMD
CH03664EActiveBPS-H80-012251CHASE BREXTON HEALTH SERVICES, INCWay Station, Inc.9030 State Route 108 STE A ColumbiaMD
CH03664FTerminatedBPS-H80-011952CHASE BREXTON HEALTH SERVICES, INCMaryland Institute College of Art Student Health Center1501 W Mount Royal Ave BaltimoreMD
CH03664GActiveBPS-H80-014468CHASE BREXTON HEALTH SERVICES, INCChase Brexton Health Care Anne Arundel Center200 Hospital Dr GLEN BURNIEMD
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH036640ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/01/2018  
CH036640ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/01/2018  
CH036640ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/01/2018  
CH036640ACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/01/2018 04/01/2024
CH036640ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/01/2018  
CH036640ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/01/2018  
CH036640ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2024  
CH036640ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280907/01/2025  
CH036640APOVIA PHARMACY SERVICES313 HENDERSON DR
SHARON HILLPA19079-103401/01/2022  
CH036640BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/01/2024  
CH036640BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/01/2024  
CH036640BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/01/2024  
CH036640BRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410604/01/2018 04/14/2021
CH036640BRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET
AVONMA0232204/01/2018 04/14/2021
CH036640CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/01/2017  
CH03664CCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/01/2017  
CH03664ABCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/01/2017  
CH03664GCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/01/2017  
CH036640CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2017  
CH03664CCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2017  
CH03664ABCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2017  
CH03664GCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2017  
CH036640CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2017  
CH03664CCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2017  
CH03664ABCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2017  
CH03664GCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2017  
CH036640CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2017  
CH03664CCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2017  
CH03664ABCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2017  
CH03664GCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2017  
CH036640CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2017  
CH03664CCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2017  
CH03664ABCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2017  
CH03664GCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2017  
CH036640CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2017  
CH03664CCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2017  
CH03664ABCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2017  
CH03664GCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2017  
CH036640CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2017  
CH03664CCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2017  
CH03664ABCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2017  
CH03664GCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2017  
CH036640CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/01/2017  
CH03664CCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/01/2017  
CH03664ABCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/01/2017  
CH03664GCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/01/2017  
CH036640CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/01/2017  
CH03664CCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/01/2017  
CH03664ABCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/01/2017  
CH03664GCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/01/2017  
CH036640CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/01/2021  
CH036640CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/01/2022  
CH036640CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/01/2022  
CH036640CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/01/2020  
CH036640CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/01/2020  
CH036640DISTRICT OF COLUMBIA CVS PHARMACY, L.L.CDBA: CVS/PHARMACY # 02787 3642 GEORGIA AVE.
WASHINGTONDC2001010/01/2020  
CH036640DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654101/01/2024  
CH036640ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/01/2022  
CH036640EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/01/2022  
CH036640EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/01/2022  
CH036640EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/01/2022  
CH036640GENOA HEALTHCARE LLC975 N SOLOMONS ISLAND RD, STE 1A
PRINCE FREDERICKMD20678-391707/01/2021  
CH036640GENOA HEALTHCARE LLCDBA GENOA HEALTHCARE, LLC #20360 10 DISTILLERY DRIVE, SUITE 200-P
WESTMINSTERMD2115707/01/2025  
CH036640GIANT PHARMACY #1593757 OLD COURT RD
PIKESVILLEMD2120804/01/2025  
CH036640GIANT PHARMACY #231810210 MILL RUN CIRCLE
OWINGS MILLSMD2111704/01/2025  
CH036640HAPPY HARRY'S INC.DBA: WALGREENS #11057 2440 CENTREVILLE ROAD
CENTREVILLEMD2161707/01/2013 01/13/2016
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01735 7400 RITCHIE HIGHWAY
GLEN BURNIEMD2106107/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02010 1102 ANNAPOLIS RD
ODENTONMD2111307/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10123 101 NORTH WOLFE ST.
BALTIMOREMD2123107/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04129 1000 TAYLOR AVE
TOWSONMD2128607/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01514 3611 BLADENSBURG ROAD
COLMAR MANORMD2072207/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05733 8124 VETERANS HWY
MILLERSVILLEMD2110807/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04302 8302 LIBERTY RD
BALTIMOREMD2124407/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04214 1013 WOODBRIDGE CTR WAY
EDGEWOODMD2104007/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 17378 28539 MARLBORO AVE
EASTONMD2160107/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07952 630 EXETER ST.
BALTIMOREMD2120207/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02216 1001 YORK ROAD
TOWSONMD2120407/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS/PHARMACY # 10751 934 NORTH CHARLES ST.
BALTIMOREMD2120107/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05381 1000 S. CHARLES ST.
BALTIMOREMD2123007/01/2020 04/02/2025
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02531 8290 OCEAN GATEWAY
EASTONMD2160107/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02160 9519 PHILADELPHIA ROAD
BALTIMOREMD2123707/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05706 7095 BALTIMORE ANNAPOLIS BLVD.
GLEN BURNIEMD2106107/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02455 2 COMPASS ROAD
BALTIMOREMD2122007/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03976 2509-2523 PENNSYLVANIA AVE.
BALTIMOREMD2121707/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04030 11623 REISTERSTOWN RD
REISTERSTOWNMD2113607/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02334 2504 N. CHARLES STREET
BALTIMOREMD2121807/01/2020 08/08/2023
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02522 3300 BELAIR RD.
BALTIMOREMD2121307/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02865 500 EASTERN AVE.
ESSEXMD2122107/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04079 5603 BALTIMORE NATIONAL PIKE
BALTIMOREMD2122807/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10094 5405 LYNX LANE
COLUMBIAMD2104407/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02034 5200 YORK ROAD
BALTIMOREMD2121207/01/2020 02/05/2025
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02066 4625 FALLS ROAD
BALTIMOREMD2120907/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04017 28 MAGOTHY BEACH RD.
PASADENAMD2112207/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16430 11200 REISTERSTOWN RD
OWINGS MILLSMD2111710/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS/PHARMACY # 10892 10201 REISTERSTOWN RD
OWINGS MILLSMD2111710/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02043 3300A CENTENNIAL LANE
ELLICOTT CITYMD2104210/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 8281 1016 S. SALISBURY BLVD
SALISBURYMD2180110/01/2020  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 17663 3559 BOSTON ST
BALTIMOREMD2122404/01/2023  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS/PHARMACY #10565 3200 ST. PAUL ST
BALTIMOREMD2121804/01/2023  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16429 6111 DOBBIN RD
COLUMBIAMD2104510/01/2023 08/02/2023
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16427 4390 MONTGOMERY RD
ELLICOTT CITYMD2104310/01/2023 08/02/2023
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 17086 1330 MARTIN BLVD
MIDDLE RIVERMD2122010/01/2023 08/02/2023
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 17086 1330 MARTIN BLVD
MIDDLE RIVERMD2122001/01/2024  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16427 4390 MONTGOMERY RD
ELLICOTT CITYMD2104301/01/2024  
CH036640MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16429 6111 DOBBIN RD
COLUMBIAMD2104501/01/2024  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02775 2601 RIVA RD.
ANNAPOLISMD2140104/01/2024  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 7139 8197 WESTSIDE BLVD.
FULTONMD2075904/01/2024  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01909 6480 OLD WATERLOO RD
ELKRIDGEMD2107507/01/2024  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05926 123 MAIN ST
ANNAPOLISMD2140104/01/2025  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04429 7845 WISE AVE.
BALTIMOREMD2122204/01/2025  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03974 5407-17 HARFORD RD
BALTIMOREMD2121407/01/2025  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00540 400 EAST PRATT STREET
BALTIMOREMD2120207/01/2025  
CH036640MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #3043 1500 RITCHIE HWY
ARNOLDMD2101207/01/2025  
CH036640OPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191304/01/2018  
CH036640OPTUM INFUSION SERVICES 103, LLC9204 BERGER RD. STE. A
COLUMBIAMD21046-172904/01/2025  
CH036640OPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/01/2025  
CH036640OPTUM INFUSION SERVICES 553, LLC6531 MERIDIEN DR SUITE 113
RALEIGHNC2761604/01/2025  
CH036640OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/01/2025  
CH036640OPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/01/2025  
CH036640OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302504/01/2025  
CH036640OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/01/2025  
CH036640OPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/01/2018  
CH036640OPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/01/2018  
CH036640OPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/01/2018  
CH036640OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
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CH036640PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
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ORLANDOFL32819-999201/01/2020 10/01/2022
CH036640PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
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CH036640RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
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CH036640RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
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CH036640SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/01/2024  
CH036640SINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
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CH036640SINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
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LOUISVILLEKY4022307/01/2024  
CH036640UNIVERSAL PHARMACY SERVICES, LLCDBA SYNERGY RX EXPRESS PHARMACY 601 NEW CASTLE AVE
WILMINGTONDE1980101/01/2022  
CH036640WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/01/2024  
CH036640WAL-MART PHARMACY 10-1875407 GEORGE CLAUSS BLVD
SEVERNMD2114410/01/2024  
CH036640WAL-MART PHARMACY 10-20458118 PERRY HILLS RD
NOTTINGHAMMD2123610/01/2024  
CH036640WAL-MART PHARMACY 10-22486205 BALTIMORE NATIONAL PIKE
CATONSVILLEMD2122810/01/2024  
CH036640WAL-MART PHARMACY 10-22796721 CHESAPEAKE CENTER DRIVE
GLEN BURNIEMD2106010/01/2024  
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CH036640WAL-MART PHARMACY 10-38048730 LIBERTY ROAD
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CH036640WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/01/2024  
CH036640WALGREEN CODBA: WALGREENS #7678 1260 LIBERTY RD
ELDERSBURGMD21784-792807/01/2013  
CH036640WALGREEN CODBA: WALGREENS #09927 735 S SALISBURY BLVD
SALISBURYMD2180107/01/2013 10/13/2017
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BALTIMOREMD2120907/01/2013  
CH036640WALGREEN CODBA: WALGREENS #10539 12400 AUTO DRIVE
CLARKSVILLEMD2102907/01/2013  
CH036640WALGREEN CO.DBA: WALGREENS # 05331 8050 LIBERTY ROAD
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CH036640WALGREEN CO.DBA: WALGREENS # 05410 19 E FAYETTE ST STE 100
BALTIMOREMD2120207/01/2013 11/06/2024
CH036640WALGREEN CO.DBA: WALGREENS #06007 5740 RITCHIE HWY
BROOKLYNMD2122507/01/2013 09/08/2017
CH036640WALGREEN CO.DBA: WALGREENS # 06265 9110 LIBERTY ROAD
RANDALLSTOWNMD2113307/01/2013  
CH036640WALGREEN CO.DBA: WALGREENS # 06320 2204 N ROLLING ROAD
BALTIMOREMD2124407/01/2013  
CH036640WALGREEN CO.DBA: WALGREENS # 06396 8606 PHILADELPHIA RD
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CH036640WALGREEN CO.DBA: WALGREENS # 06779 9616 HARFORD ROAD
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CH036640WALGREEN CO.DBA: WALGREENS # 07357 3005 EMMORTON ROAD
ABINGDONMD2100907/01/2013 09/08/2017
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CH036640WALGREEN CO.DBA: WALGREENS # 07574 5657 BALTIMORE NATIONAL PIKE
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CH036640WALGREEN CO.DBA: WALGREENS # 11283 1802 MAIN ST
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CH036640WALGREEN CO.DBA: WALGREENS #12790 6323 BALTIMORE NATIONAL PIKE
CATONSVILLEMD2122807/01/2013  
CH036640WALGREEN CO.DBA: WALGREENS #12847 1801 YORK RD
LUTHERVILLEMD2109307/01/2013 01/13/2016
CH036640WALGREEN CO.DBA: WALGREENS #13149 1075 SEVEN LOCKS RD
ROCKVILLEMD20854-290307/01/2013 01/13/2016
CH036640WALGREEN CO.WALGREENS SPECIALTY PHARMACY #15308 6 N HOWARD ST
BALTIMOREMD2120107/01/2013  
CH036640WALGREEN CO.DBA: WALGREENS #16190 301 SAINT PAUL ST
BALTIMOREMD2120201/01/2018 02/18/2025
CH036640WALGREEN CO.DBA: WALGREENS # 05686 401 COMPASS RD E
BALTIMOREMD2122001/01/2018  
CH036640WALGREEN CO.DBA: WALGREENS # 05623 3801 LIBERTY HEIGHTS AVE
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CH036640WALGREEN CO.COMMUNITY, A WALGREENS PHARMACY #21166 1114 CATHEDRAL ST.
SUITE 3
BALTIMOREMD2120104/01/2019  
CH036640WALGREEN CO.WALGREENS #19129 11917 REISTERSTOWN RD # 19
REISTERSTOWNMD21136-303007/01/2019  
CH036640WALGREEN CO.WALGREENS #18337 3700 FALLS RD
BALTIMOREMD2121107/01/2019 11/12/2024
CH036640WALGREEN CO.WALGREENS #19336 9810 APOLLO DR
LARGOMD2077407/01/2019  
CH036640WALGREEN CO.WALGREENS #19374 6622 SECURITY BLVD # 24
BALTIMOREMD21207-401007/01/2019 09/18/2023
CH036640WALGREEN CO.WALGREENS #19401 711 W 40TH ST
BALTIMOREMD21211-212007/01/2019 05/03/2023
CH036640WALGREEN CO.WALGREENS #17609 300 MARTIN LUTHER KING JR BLVD
BALTIMOREMD2120107/01/2019 11/16/2023
CH036640WALGREEN CO.WALGREENS #17522 238 MCMECHEN ST
BALTIMOREMD2121707/01/2019  
CH036640WALGREEN CO.WALGREENS #17966 7270 MONTGOMERY RD
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CH036640WALGREEN CO.WALGREENS #19383 1132 ANNAPOLIS RD
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CH036640WALGREEN CO.DBA: WALGREENS #16188 2000 W. BALTIMORE STREET
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CH036640WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
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CH036640WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/01/2020  
CH036640WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
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CH036640WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/01/2020  
CH036640WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275610/01/2024  
CH036640Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616810/01/2024  
CH036640WIENNERMT. VERNON PHARMACY 900 CATHEDRAL ST
MT VERNON PHARMACY
BALTIMOREMD21201-531101/01/2021  
CH036640YORK RD PHARMACYDBA AS LUTHERVILLE PHARMACY 1776 YORK RD
LUTHERVILLEMD2109307/01/2025  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/6/2024 9:15:41 AM2/10/2025 11:14:41 AM2/10/2025 11:14 AM
AddressesShipping AddressUpdateChange RequestChase Brexton Health Care 200 Hospital Dr #300 Glen Burnie, MD 21061-3961Chase Brexton Health Care 200 Hospital Dr #500 Glen Burnie, MD 21061-39615/2/2024 8:42 AM
DetailsLast Recertification DateUpdateRecertification2/2/2023 11:55:00 AM2/6/2024 9:15:41 AM2/6/2024 9:15 AM
DetailsLast Recertification DateUpdateRecertification2/9/2022 11:41:33 AM2/2/2023 11:55:00 AM2/2/2023 11:55 AM
AddressesShipping AddressUpdateChange RequestChase Brexton Health Care 200 Hospital Dr #506 Glen Burnie, MD 21061-3961Chase Brexton Health Care 200 Hospital Dr #300 Glen Burnie, MD 21061-39616/21/2022 11:53 AM
AddressesShipping AddressInsertChange Request Chase Brexton Health Care 200 Hospital Dr #506 Glen Burnie, MD 21061-39616/7/2022 11:56 AM
DetailsLast Recertification DateUpdateRecertification2/12/2021 3:28:50 PM2/9/2022 11:41:33 AM2/9/2022 11:41 AM
ContactsAuthorizing OfficialUpdateAO Change RequestMutch, Patrick CEO CBHC 4108372050-2218Turnbaugh, Eric CFO Chase Brexton Health Care 4108372050-11482/16/2021 8:55 AM
Medicaid BillingNPI: StateUpdateRecertification MD2/12/2021 3:28 PM
Medicaid BillingNPI: StateUpdateRecertification MD2/12/2021 3:28 PM
Medicaid BillingNPI: StateUpdateRecertification MD2/12/2021 3:28 PM
Medicaid BillingNPI: StateUpdateRecertification MD2/12/2021 3:28 PM
Medicaid BillingNPI: StateUpdateRecertification MD2/12/2021 3:28 PM
Medicaid BillingNPI: StateUpdateRecertification MD2/12/2021 3:28 PM
DetailsLast Recertification DateUpdateRecertification1/27/2020 11:07:47 AM2/12/2021 3:28:50 PM2/12/2021 3:28 PM
DetailsLast Recertification DateUpdateRecertification2/19/2019 11:07:47 AM1/27/2020 11:07:47 AM1/27/2020 11:07 AM
ContactsPrimary ContactUpdateChange RequestSummerfield, Marc AVP - Pharmacy Chase Brexton Health Care 4108372050-1490Cywinski, Jeffrey Allen Director of Pharmacy Chase Brexton Health Care 4108372050-111512/10/2019 2:06 PM
ContactsAuthorizing OfficialUpdateChange RequestBrooks, Robin CFO Chase Brexton 4107520954-1148Mutch, Patrick CEO CBHC 4108372050-22186/25/2019 10:23 AM
Medicaid BillingNPI: NumberInsertRecertification 11847221752/19/2019 11:07 AM
Medicaid BillingNPI: NumberInsertRecertification 15786995752/19/2019 11:07 AM
Medicaid BillingNPI: NumberInsertRecertification 15980366182/19/2019 11:07 AM
Medicaid BillingNPI: NumberInsertRecertification 19821184442/19/2019 11:07 AM
DetailsLast Recertification DateUpdateRecertification2/8/2018 4:09:18 PM2/19/2019 11:07:47 AM2/19/2019 11:07 AM
DetailsIs Authorizing Official EHB DataUpdateRecertificationFalse 2/19/2019 11:07 AM
DetailsLast Recertification DateUpdateRecertification1/31/2017 12:00:00 AM2/8/2018 4:09:18 PM2/8/2018 4:09 PM
ContactsAuthorizing OfficialUpdate Brooks, Robin CFO 4107520954-1148Brooks, Robin CFO Chase Brexton 4107520954-114810/12/2017 2:42 PM
ContactsSigned ByUpdate Brooks, Robin CFO 4107520954-1148Brooks, Robin CFO Chase Brexton 4107520954-114810/12/2017 2:42 PM
ContactsPrimary ContactUpdate Summerfield, Marc AVP - Pharmacy 4108372050-1490Summerfield, Marc AVP - Pharmacy Chase Brexton Health Care 4108372050-149010/11/2017 8:02 AM
ContactsAuthorizing OfficialInsert  Brooks, Robin CFO 4107520954-11487/25/2017 3:54 PM
ContactsSigned ByInsert  Brooks, Robin CFO 4107520954-11487/25/2017 3:54 PM
ContactsPrimary ContactUpdate White, Robert COO 4108372050-1086Summerfield, Marc AVP - Pharmacy 4108372050-14903/14/2017 10:17 AM
AddressesMain AddressInsert   200 Hospital Dr GLEN BURNIE, MD 21061-39613/14/2017 10:15 AM
AddressesBilling AddressInsert  Chase Brexton Health Services, Inc 1111 N. Charles Street Baltimore, MD 212013/14/2017 10:15 AM
Medicaid BillingNPI: NumberInsert  19124583813/14/2017 10:15 AM
Medicaid BillingNPI: NumberInsert  14971614833/14/2017 10:15 AM
DetailsLast Recertification DateUpdate 2/18/2016 12:00:00 AM1/31/2017 12:00:00 AM1/31/2017 2:25 PM
ContactsPrimary ContactUpdate Akinlosotu, Caroline Director of Pharmacy 4108372050-1490White, Robert COO 4108372050-10862/22/2016 1:01 PM
DetailsLast Recertification DateUpdate 3/3/2015 12:00:00 AM2/18/2016 12:00:00 AM2/18/2016 4:33 PM
ContactsPrimary ContactInsert  Akinlosotu, Caroline Director of Pharmacy 4108372050-14903/26/2015 4:34 PM
DetailsLast Recertification DateUpdate  3/3/2015 12:00:00 AM3/3/2015 9:38 AM
DatesParticipating Approval DateUpdate  10/16/2014 12:00:00 AM10/16/2014 5:42 PM
DetailsStateUpdate PendingActive10/16/2014 5:42 PM
DatesStart DateUpdate  1/1/2015 12:00:00 AM10/16/2014 5:42 PM
Details340B IDUpdate ONLINE_REG_46825CH03664G10/8/2014 5:04 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_4682510/8/2014 4:08 PM
DetailsLast Recertification DateInsert   10/8/2014 4:08 PM
DetailsGrant NumberInsert  H80CS0073410/8/2014 4:08 PM
Details340B IDInsert  ONLINE_REG10/8/2014 4:08 PM
DetailsIs Authorizing Official EHB DataInsert  False10/8/2014 4:08 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/8/2014 4:08 PM
DetailsMedicare Provider NumberInsert   10/8/2014 4:08 PM
DetailsEntity NameInsert  CHASE BREXTON HEALTH SERVICES, INC10/8/2014 4:08 PM
DetailsProgram CodeInsert  CH10/8/2014 4:08 PM
DetailsEntity SubnameInsert  Chase Brexton Health Care Anne Arundel Center10/8/2014 4:08 PM
DatesParticipating Approval DateInsert   10/8/2014 4:08 PM
DetailsStateInsert  Pending10/8/2014 4:08 PM
DatesRegistration DateInsert  10/8/2014 12:00:00 AM10/8/2014 4:08 PM
DatesSigned By DateInsert  10/8/2014 12:00:00 AM10/8/2014 4:08 PM
DatesStart DateInsert   10/8/2014 4:08 PM
TerminationsTermination CommentsInsert   10/8/2014 4:08 PM
TerminationsTermination DateInsert   10/8/2014 4:08 PM
TerminationsTermination Effective DateInsert   10/8/2014 4:08 PM
TerminationsTermination ReasonInsert   10/8/2014 4:08 PM