Contract Pharmacy Details

CAREMARK, L.L.C.
DSH210043 BALTIMORE WASHINGTON MEDICAL CENTER

Covered Entity Details

Entity Name

BALTIMORE WASHINGTON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210043

Entity Address

301 HOSPITAL DRIVE
GLEN BURNIE, MD 21061

Medicare Provider Number

210043

Participating Start Date

1/1/2025

Last Recertification Date

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

CAREMARK, L.L.C.

Pharmacy Address

DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119

Pharmacy Comments

Contract Details

Approval Date

5/5/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Alfred Alan Pietsch, SVP & CFO
(410) 787-4160

Contract Pharmacy Representative

CVS
Derek Stearns, National Sales Executive
(503) 317-9840

Signed By Date

4/15/2022

340B Drug Pricing Program Database