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MARYLAND CVS PHARMACY, L.L.C.
CH036640 CHASE BREXTON HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
CHASE BREXTON HEALTH SERVICES, INC
Subdivision Name
Chase Brexton Health Services, Inc.
Type
HRSA-Funded Health Center
340B ID
CH036640
Entity Address
1111 North Charles Street
Baltimore, MD 21201-5505
Grant Number
H80CS00734
Participating Start Date
4/1/1997
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01514
3611 BLADENSBURG ROAD
COLMAR MANOR, MD 20722
Pharmacy Comments
Contract Details
Approval Date
4/2/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Mutch, CEO
(410) 837-2050 Ext: 2218
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/2/2020
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