Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
DSH210008 MERCY MEDICAL CENTER

Covered Entity Details

Entity Name

MERCY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210008

Entity Address

345 ST. PAUL PLACE
BALTIMORE, MD 21202

Medicare Provider Number

210008

Participating Start Date

10/1/2002

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03976
2509-2523 PENNSYLVANIA AVE.
BALTIMORE, MD 21217

Pharmacy Comments

Contract Details

Approval Date

7/1/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gregory Paul Smith, VP & Chief Pharmacy Officer
(410) 332-9627

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/1/2020

340B Drug Pricing Program Database