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WALGREEN CO.
CH03377J GREATER BADEN MEDICAL SERVICE INC
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Covered Entity Details
Entity Name
GREATER BADEN MEDICAL SERVICE INC
Subdivision Name
Greater Baden Medical Services at Capitol Heights II
Type
HRSA-Funded Health Center
340B ID
CH03377J
Entity Address
1442 Addison Rd S
Capitol Heights, MD 20743-4413
Grant Number
H80CS00549
Participating Start Date
7/1/2015
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
WALGREENS #17859
5741 SILVER HILL RD
DISTRICT HEIGHTS, MD 20747
Pharmacy Comments
Contract Details
Approval Date
7/14/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher A DeMarco, Chief Executive Officer
(301) 888-2233 Ext: 3306
Contract Pharmacy Representative
Greater Baden Medical Services, Inc.
David Houston, Pharmacist
(301) 888-2233 Ext: 3220
Signed By Date
7/14/2020
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