340B Drug Pricing Program Database


CH03013E PARK WEST HEALTH SYSTEMS INCORPORATED (Terminated) - information as of 5/7/2025 10:45:41 PM

Main Details
PARK WEST HEALTH SYSTEMS INCORPORATED
Howard Park Community Care Clinic
HRSA-Funded Health Center
BPS-H80-014187
CH03013E
H80CS00067


Additional Details
Terminated
1/15/2015
4/1/2015
1/21/2015
2/3/2017

4/1/2018
Site closure

Contacts

Park West Health System, Inc.
ALLEN J. BENNETT, PRESIDENT & CEO
(410) 542-7800 Ext: 7501

Park West Health System, Inc.
ALLEN J. BENNETT, PRESIDENT & CEO
(410) 542-7800 Ext: 7501

Addresses

4601 Liberty Heights Avenue
Baltimore, MD 21215-2120

Same as Street Address


  • 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
MD912391100 
  1619187218
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CH030130ActiveBPS-H80-001231PARK WEST HEALTH SYSTEMS INCORPORATEDPARK WEST MEDICAL CENTER - BELVEDERE3319 W Belvedere Ave BaltimoreMD
CH03013BActiveBPS-H80-005299PARK WEST HEALTH SYSTEMS INCORPORATEDPARK WEST MEDICAL CENTER - PLAZA SITE4120 PATTERSON AVE BALTIMOREMD
CH03013CTerminatedBPS-H80-000639PARK WEST HEALTH SYSTEMS INCORPORATEDPARK WEST MEDICAL CENTER SCC/GPA5101 LANIER AVE BALTIMOREMD
CH03013DActiveBPS-H80-000268PARK WEST HEALTH SYSTEMS INCORPORATEDPARK WEST MEN & FAMILY HLTH CTR4151 Park Heights Ave BaltimoreMD
CH03013ETerminatedBPS-H80-014187PARK WEST HEALTH SYSTEMS INCORPORATEDHoward Park Community Care Clinic4601 Liberty Heights Avenue BaltimoreMD
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CH030130ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280904/01/2025  
CH030130APOVIA PHARMACY SERVICES313 HENDERSON DR
SHARON HILLPA19079-103410/01/2020  
CH030130CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2025  
CH030130CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2025  
CH030130CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2025  
CH030130CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2025  
CH030130CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2025  
CH030130CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2025  
CH030130CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2025  
CH030130CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2025  
CH030130CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2025  
CH030130CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2025  
CH030130CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2025  
CH030130CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/01/2025  
CH030130GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09540 2521 EASTBLUFF DRIVE
NEWPORT BEACHCA9266004/01/2025  
CH030130GREATER PHILADELPHIA PHARMACYUNIVERSAL PHARMACY SERVICES 432 N 6TH. ST.
PHILADELPHIAPA19123-400410/01/2020  
CH030130LUTHERVILLE PHARMACY1776 YORK RD
LUTHERVILLEMD2109307/01/2023  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01501 19100 MONTGOMERY VILLAGE AVE.
GAITHERSBURGMD2088604/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01510 2600 ANNAPOLIS RD.
SEVERNMD2114404/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01790 15100 BALTIMORE AVE.
LAURELMD2070704/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02010 1102 ANNAPOLIS RD
ODENTONMD2111304/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02034 5200 YORK ROAD
BALTIMOREMD2121204/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02045 2911 E JOPPA RD
PARKVILLEMD21234-302104/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02066 4625 FALLS ROAD
BALTIMOREMD2120904/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02160 9519 PHILADELPHIA ROAD
BALTIMOREMD2123704/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02216 1001 YORK ROAD
TOWSONMD2120404/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02522 3300 BELAIR RD.
BALTIMOREMD2121304/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02865 500 EASTERN AVE.
ESSEXMD2122104/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03974 5407-17 HARFORD RD
BALTIMOREMD2121404/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03976 2509-2523 PENNSYLVANIA AVE.
BALTIMOREMD2121704/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04030 11623 REISTERSTOWN RD
REISTERSTOWNMD2113604/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04079 5603 BALTIMORE NATIONAL PIKE
BALTIMOREMD2122804/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04129 1000 TAYLOR AVE
TOWSONMD2128604/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04302 8302 LIBERTY RD
BALTIMOREMD2124404/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04411 5501 PARK HEIGHTS AVE
BALTIMOREMD2121504/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04429 7845 WISE AVE.
BALTIMOREMD2122204/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04438 6635-37 BELAIR RD
BALTIMOREMD2120604/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04602 900 EDMONDSON AVE
BALTIMOREMD2122804/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05381 1000 S. CHARLES ST.
BALTIMOREMD2123004/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07656 3915 HOLLINS FERRY ROAD
BALTIMOREMD2122704/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07952 630 EXETER ST.
BALTIMOREMD2120204/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10094 5405 LYNX LANE
COLUMBIAMD2104404/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10123 101 NORTH WOLFE ST.
BALTIMOREMD2123104/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS/PHARMACY #10565 3200 ST. PAUL ST
BALTIMOREMD2121804/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS/PHARMACY # 10588 4701 WILKENS AVE
CATONSVILLEMD2122804/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS/PHARMACY # 10751 934 NORTH CHARLES ST.
BALTIMOREMD2120104/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS/PHARMACY # 10892 10201 REISTERSTOWN RD
OWINGS MILLSMD2111704/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16427 4390 MONTGOMERY RD
ELLICOTT CITYMD2104304/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16429 6111 DOBBIN RD
COLUMBIAMD2104504/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16430 11200 REISTERSTOWN RD
OWINGS MILLSMD2111704/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16612 9901 YORK RD
COCKEYSVILLEMD2103004/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 16870 1737 REISTERSTOWN RD
PIKESVILLEMD2120804/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 17055 6717 RITCHIE HWY
GLEN BURNIEMD2106104/01/2025  
CH030130MARYLAND CVS PHARMACY, L.L.C.CVS PHARMACY # 17663 3559 BOSTON ST
BALTIMOREMD2122404/01/2025  
CH030130PENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 2575 4035 N. GEORGE ST.
MANCHESTERPA1734504/01/2025  
CH030130PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2025  
CH030130PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2025  
CH030130PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/01/2025  
CH030130PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #48611 141 PREBLE STREET
PORTLANDME0410104/01/2025  
CH030130VDN PHARMACY LLCLIFELINE BALTIMORE PHARMACY 6821 REISTERSTOWN RD
STE 207 		BALTIMOREMD2121507/01/2023  
CH030130WALGREEN COCOMMUNITY A WALGREENS PHARMACY #15298 1325 14TH STREET NW
WASHINGTONDC2000504/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS # 05623 3801 LIBERTY HEIGHTS AVE
BALTIMOREMD2121504/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS # 05638 4025 W NORTHERN PKWY
BALTIMOREMD2121504/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS # 06265 9110 LIBERTY ROAD
RANDALLSTOWNMD2113304/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS # 06320 2204 N ROLLING ROAD
BALTIMOREMD2124404/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS # 06396 8606 PHILADELPHIA RD
ROSEDALEMD2123704/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS # 09028 6700 RITCHIE HWY
GLEN BURNIEMD21061-231904/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS #12560 1510 REISTERSTOWN ROAD
PIKESVILLEMD2120804/01/2025  
CH030130WALGREEN CO.WALGREENS SPECIALTY PHARMACY #15308 6 N HOWARD ST
BALTIMOREMD2120104/01/2025  
CH030130WALGREEN CO.DBA: WALGREENS #16191 2411 W. BELVEDERE AVENUE
SUITE 101 		BALTIMOREMD2121504/01/2025  
CH030130WALGREEN CO.WALGREENS #17587 6838 LOCH RAVEN BLVD
BALTIMOREMD2128604/01/2025  
CH030130WALGREEN CO.COMMUNITY, A WALGREENS PHARMACY #21142 1015 RIPLEY STREET
STE B 		SILVER SPRINGMD2091004/01/2025  
CH030130WALGREEN CO.COMMUNITY, A WALGREENS PHARMACY #21166 1114 CATHEDRAL ST.
SUITE 3 		BALTIMOREMD2120104/01/2025  
CH030130WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/2025  
CH030130WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/2025  
CH030130WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/2025  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated4/1/2018 12:00 AM
DatesLast Date That 340B Drugs PurchasedUpdateRecertification 10/21/2017 12:00:00 AM2/15/2018 8:07 AM
DetailsStateUpdateRecertificationActiveTo Be Terminated2/15/2018 8:07 AM
TerminationsTermination DateUpdateRecertification 4/1/2018 12:00:00 AM2/15/2018 8:07 AM
TerminationsTermination Effective DateUpdateRecertification 10/21/2017 12:00:00 AM2/15/2018 8:07 AM
TerminationsTermination ReasonUpdateRecertification Site closure2/15/2018 8:07 AM
ContactsAuthorizing OfficialUpdate BENNETT, ALLEN J. PRESIDENT & CEO 4105427800-7501BENNETT, ALLEN J. PRESIDENT & CEO Park West Health System, Inc. 4105427800-75012/14/2018 2:51 PM
ContactsPrimary ContactUpdate BENNETT, ALLEN J. PRESIDENT & CEO 4105427800-7501BENNETT, ALLEN J. PRESIDENT & CEO Park West Health System, Inc. 4105427800-75012/14/2018 2:51 PM
ContactsSigned ByUpdate BENNETT, ALLEN J. PRESIDENT & CEO 4105427800-7501BENNETT, ALLEN J. PRESIDENT & CEO Park West Health System, Inc. 4105427800-75012/14/2018 2:51 PM
AddressesMain AddressInsert   4601 Liberty Heights Avenue Baltimore, MD 21215-21202/3/2017 10:47 AM
ContactsAuthorizing OfficialInsert  BENNETT, ALLEN J. PRESIDENT & CEO 4105427800-75012/3/2017 10:47 AM
ContactsPrimary ContactInsert  BENNETT, ALLEN J. PRESIDENT & CEO 4105427800-75012/3/2017 10:47 AM
ContactsSigned ByInsert  BENNETT, ALLEN J. PRESIDENT & CEO 4105427800-75012/3/2017 10:47 AM
DetailsLast Recertification DateUpdate 2/18/2016 12:00:00 AM2/3/2017 12:00:00 AM2/3/2017 10:47 AM
DetailsLast Recertification DateUpdate  2/18/2016 12:00:00 AM2/18/2016 1:17 PM
Details340B IDUpdate  CH03013ECH03013E3/16/2015 7:36 AM
DatesParticipating Approval DateUpdate  1/21/2015 12:00:00 AM1/21/2015 11:09 AM
DetailsStateUpdate PendingActive1/21/2015 11:09 AM
DatesStart DateUpdate  4/1/2015 12:00:00 AM1/21/2015 11:09 AM
DetailsGrant NumberUpdate  H80CS000671/21/2015 11:01 AM
DetailsGrant NumberUpdate H80CS00067 1/20/2015 12:45 PM
Details340B IDUpdate ONLINE_REG_49950 CH03013E1/20/2015 12:45 PM
Details340B IDUpdate ONLINE_REGONLINE_REG_499501/15/2015 5:20 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False1/15/2015 5:19 PM
Medicaid BillingMedicaid: NumberInsert  9123911001/15/2015 5:19 PM
Medicaid BillingMedicaid: StateInsert  MD1/15/2015 5:19 PM
Medicaid BillingNPI: NumberInsert  16191872181/15/2015 5:19 PM
DetailsLast Recertification DateInsert   1/15/2015 5:19 PM
DetailsGrant NumberInsert  H80CS000671/15/2015 5:19 PM
Details340B IDInsert  ONLINE_REG1/15/2015 5:19 PM
DetailsIs Authorizing Official EHB DataInsert  False1/15/2015 5:19 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/15/2015 5:19 PM
DetailsMedicare Provider NumberInsert   1/15/2015 5:19 PM
DetailsEntity NameInsert  PARK WEST HEALTH SYSTEMS INCORPORATED1/15/2015 5:19 PM
DetailsProgram CodeInsert  CH1/15/2015 5:19 PM
DetailsEntity SubnameInsert  Howard Park Community Care Clinic1/15/2015 5:19 PM
DatesParticipating Approval DateInsert   1/15/2015 5:19 PM
DetailsStateInsert  Pending1/15/2015 5:19 PM
DatesRegistration DateInsert  1/15/2015 12:00:00 AM1/15/2015 5:19 PM
DatesSigned By DateInsert  1/15/2015 12:00:00 AM1/15/2015 5:19 PM
DatesStart DateInsert   1/15/2015 5:19 PM
TerminationsTermination CommentsInsert   1/15/2015 5:19 PM
TerminationsTermination DateInsert   1/15/2015 5:19 PM
TerminationsTermination Effective DateInsert   1/15/2015 5:19 PM
TerminationsTermination ReasonInsert   1/15/2015 5:19 PM