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MT. PLEASANT CARE PHARMACY
CH037030 Mary's Center For Maternal And Child Care, Inc.
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Covered Entity Details
Entity Name
Mary's Center For Maternal And Child Care, Inc.
Subdivision Name
Adams Morgan DC
Type
HRSA-Funded Health Center
340B ID
CH037030
Entity Address
2333 Ontario Rd NW
Washington, DC 20009-2627
Grant Number
H80CS04202
Participating Start Date
7/1/2014
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
MT. PLEASANT CARE PHARMACY
Pharmacy Address
3169 MOUNT PLEASANT ST NW
WASHINGTON, DC 20010-2709
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/11/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dara Koppelman, EVP of Health Services and Programs
(202) 545-2063
Contract Pharmacy Representative
Mount Pleasant Care Pharmacy
Syam Bandi, Owner
(202) 387-3100
Signed By Date
7/15/2020
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