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MARYLAND CVS PHARMACY, L.L.C.
CH033770 GREATER BADEN MEDICAL SERVICE INC
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Covered Entity Details
Entity Name
GREATER BADEN MEDICAL SERVICE INC
Subdivision Name
Greater Baden Medical Services at Brandywine
Type
HRSA-Funded Health Center
340B ID
CH033770
Entity Address
7450 Albert Road
Brandywine, MD 20613
Grant Number
H80CS00549
Participating Start Date
4/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01453
5707 RIVERDALE ROAD
RIVERDALE, MD 20737
Pharmacy Comments
Contract Details
Approval Date
4/18/2022
Contract Begin Date
4/22/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher A DeMarco, Chief Executive Officer
(301) 888-2233 Ext: 3306
Contract Pharmacy Representative
Wellpartner
Bryn Wolgemuth, Account Manager
(917) 607-0428
Signed By Date
4/18/2022
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