Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
CHC10591-07 COMMUNITY CLINIC, INC., THE

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC., THE

Subdivision Name

CCI Gaithersburg Dental

Type

HRSA-Funded Health Center

340B ID

CHC10591-07

Entity Address

200 Girard St. STE 206
Gaithersburg, MD 20877-3490

Grant Number

H80CS10591

Participating Start Date

1/1/2014

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02016
5910 GREENBELT ROAD
GREENBELT, MD 20770

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Sonya J. Bruton, CEO and President
(240) 839-5107

Contract Pharmacy Representative

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

Signed By Date

7/15/2020

340B Drug Pricing Program Database