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SAM'S PHARMACY 10-4771
CH031270 FAMILY HEALTH CENTERS OF BALTIMORE, INC.
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Covered Entity Details
Entity Name
FAMILY HEALTH CENTERS OF BALTIMORE, INC.
Subdivision Name
HEADQUARTERS
Type
HRSA-Funded Health Center
340B ID
CH031270
Entity Address
631 CHERRY HILL ROAD
BALTIMORE, MD 21225
Grant Number
H80CS00436
Participating Start Date
7/1/1996
Last Recertification Date
1/30/2023
Entity Termination Date
1/1/2024
Pharmacy Details
Pharmacy Name
SAM'S PHARMACY 10-4771
Pharmacy Address
424 GEORGE CLAUSS BLVD
SEVERN, MD 21144
Pharmacy Comments
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Brian Aoki Hawkins, President and Chief Executive Officer
(410) 354-2001
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/11/2019
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