340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MARYLAND CVS PHARMACY, L.L.C.
DSH210056 GOOD SAMARITAN HOSPITAL
Print
Covered Entity Details
Entity Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210056
Entity Address
5601 LOCH RAVEN BLVD
BALTIMORE, MD 21239
Medicare Provider Number
210056
Participating Start Date
4/1/2018
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02034
5200 YORK ROAD
BALTIMORE, MD 21212
Pharmacy Comments
Contract Details
Approval Date
4/10/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deana Stout, VP FINANCE
(410) 554-2228
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
4/10/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session