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RIVERSIDE PHARMACY, LLC
CH03301H THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
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Covered Entity Details
Entity Name
THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
Subdivision Name
THREE LOWER COUNTIES COMMUNITY SVCS INC
Type
HRSA-Funded Health Center
340B ID
CH03301H
Entity Address
12145 Elm St
Princess Anne, MD 21853-1358
Grant Number
H80CS00774
Participating Start Date
4/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RIVERSIDE PHARMACY, LLC
Pharmacy Address
540 RIVERSIDE DR
SALISBURY, MD 21801-5352
Pharmacy Comments
Contract Details
Approval Date
1/4/2022
Contract Begin Date
1/14/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
brian edward holland, ceo
(410) 749-1015 Ext: 1621
Contract Pharmacy Representative
Milford Street Pharmacy
Sanjay Rayathatha, Owner
(410) 948-0554
Signed By Date
1/4/2022
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