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DELAWARE CVS PHARMACY, L.L.C.
DSH210032 UNION HOSPITAL OF CECIL COUNTY
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Covered Entity Details
Entity Name
UNION HOSPITAL OF CECIL COUNTY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210032
Entity Address
106 BOW STREET
ELKTON, MD 21921
Medicare Provider Number
210032
Participating Start Date
10/1/2015
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
DELAWARE CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #10375
674 MIDDLETOWN ODESSA ROAD
MIDDLETOWN, DE 19709
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James G. Raab, CFO
(410) 392-7095
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2019
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