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WAL-MART PHARMACY 10-3804
CH033180 BALTIMORE MEDICAL SYSTEM, INC.
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Covered Entity Details
Entity Name
BALTIMORE MEDICAL SYSTEM, INC.
Subdivision Name
BMS at Yard 56
Type
HRSA-Funded Health Center
340B ID
CH033180
Entity Address
5525 Eastern Avenue
Suite 301
Baltimore, MD 21224-2029
Grant Number
H80CS00800
Participating Start Date
10/1/1998
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3804
Pharmacy Address
8730 LIBERTY ROAD
RANDALLSTOWN, MD 21133
Pharmacy Comments
Contract Details
Approval Date
1/21/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shirley Sutton, Chief Executive Officer
(410) 558-4891
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/21/2020
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