Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
CHC10591-05 COMMUNITY CLINIC, INC., THE

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC., THE

Subdivision Name

CCI-Greenbelt

Type

HRSA-Funded Health Center

340B ID

CHC10591-05

Entity Address

7615 Ora Glen Drive
Greenbelt, MD 20770-1004

Grant Number

H80CS10591

Participating Start Date

1/1/2014

Last Recertification Date

2/1/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01439
10113 NEW HAMPSHIRE AVENUE
SILVER SPRING, MD 20903

Pharmacy Comments

Contract Details

Approval Date

1/18/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/29/2023
Pharmacy closed

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

1/18/2022

340B Drug Pricing Program Database