Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
CHC10591-02 COMMUNITY CLINIC, INC.

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC.

Subdivision Name

CCI-GAITHERSBURG

Type

HRSA-Funded Health Center

340B ID

CHC10591-02

Entity Address

220 GIRARD ST
Suite 100
GAITHERSBURG, MD 20877

Grant Number

H80CS10591

Participating Start Date

7/1/2009

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01453
5707 RIVERDALE ROAD
RIVERDALE, MD 20737

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

Kathleen Knolhoff, CEO & President
(240) 499-2609

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