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MARYLAND CVS PHARMACY, L.L.C.
DSH210002 UNIVERSITY OF MARYLAND MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF MARYLAND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210002
Entity Address
22 SOUTH GREENE STREET
BALTIMORE, MD 21201
Medicare Provider Number
210002
Participating Start Date
10/1/2001
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07952
630 EXETER ST.
BALTIMORE, MD 21202
Pharmacy Comments
Contract Details
Approval Date
10/11/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Craig Fleischmann, Vice President of Finance
(410) 328-1092
Contract Pharmacy Representative
CVS Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
10/11/2021
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