340B Drug Pricing Program Database
WALGREEN CO.
DSH210008 MERCY MEDICAL CENTER - information as of 5/27/2025 1:05:30 PM
Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210008
Entity Address
345 ST. PAUL PLACE
BALTIMORE, MD 21202
Medicare Provider Number
210008
Participating Start Date
10/1/2002
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 21331
2001 W PATAPSCO AVE
BALTIMORE, MD 21230
Pharmacy Comments
Contract Details
Approval Date
1/14/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/13/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Morrell Delcher, VP & Chief Pharmacy Officer
(410) 332-9627
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2014
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