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BEDFORD ROAD PHARMACY, INC. DBA
CHC06642-00 WESTERN MARYLAND HEALTH CARE CORPORATION
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Covered Entity Details
Entity Name
WESTERN MARYLAND HEALTH CARE CORPORATION
Subdivision Name
Mountain Laurel Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC06642-00
Entity Address
1027 Memorial Dr
Oakland, MD 21550-4343
Grant Number
H80CS06642
Participating Start Date
4/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
BEDFORD ROAD PHARMACY, INC. DBA
Pharmacy Address
THE MEDICINE SHOPPE OF GRANTSVILLE
149 MAIN ST
GRANTSVILLE, MD 21536
Pharmacy Comments
Contract Details
Approval Date
7/3/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/30/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Charles Lee Wilt, CEO
(301) 533-3300 Ext: 3056
Contract Pharmacy Representative
Medicine Shoppe
Randy Trumbule, Director of Retail Pharmacy
(301) 895-5177
Signed By Date
7/3/2018
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