Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
CHC10591-13 Community Clinic, Inc., The

Covered Entity Details

Entity Name

Community Clinic, Inc., The

Subdivision Name

CCI-Wheaton

Type

HRSA-Funded Health Center

340B ID

CHC10591-13

Entity Address

2730 University Blvd W Ste ll10
Wheaton, MD 20902-1905

Grant Number

H80CS10591

Participating Start Date

7/1/2021

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01501
19100 MONTGOMERY VILLAGE AVE.
GAITHERSBURG, MD 20886

Pharmacy Comments

Contract Details

Approval Date

7/14/2021

Contract Begin Date

10/1/2021

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

7/14/2021

340B Drug Pricing Program Database