Contract Pharmacy Details

MEDLY BALTIMORE INC.
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

MEDLY BALTIMORE INC.

Pharmacy Address

MEDLY PHARMACY
300 SAINT PAUL PL
BALTIMORE, MD 21202-2120

Pharmacy Comments

Contract Details

Approval Date

1/14/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/1/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Medly Pharmacy
Nate Coney, VP
(609) 992-9692

Signed By Date

1/14/2021

340B Drug Pricing Program Database