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WAL-MART PHARMACY 10-2799
CH033770 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 Brandywine
Type
HRSA-Funded Health Center
340B ID
CH033770
Entity Address
7450 Albert Road
Brandywine, MD 20613
Grant Number
H80CS00549
Participating Start Date
4/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2799
Pharmacy Address
8745 BRANCH AVENUE
CLINTON, MD 20735
Pharmacy Comments
Contract Details
Approval Date
1/22/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
colenthia malloy, chief executive officer
(301) 836-9652
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/22/2015
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