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MARYLAND CVS PHARMACY, L.L.C.
CH036820 LA CLINICA DEL PUEBLO
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Covered Entity Details
Entity Name
LA CLINICA DEL PUEBLO
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH036820
Entity Address
2831 15TH STREET NW
WASHINGTON, DC 20009
Grant Number
H80CS08244
Participating Start Date
1/1/2008
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05460
19901 FREDERICK RD.,
GERMANTOWN, MD 20876
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Catalina Sol, Executive Director
(202) 448-2810
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/15/2020
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