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MARYLAND CVS PHARMACY, L.L.C.
RWI200091A District of Columbia Department of Health
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Covered Entity Details
Entity Name
District of Columbia Department of Health
Subdivision Name
Us Helping Us, People Into Living, Inc.
Type
Ryan White Part A
340B ID
RWI200091A
Entity Address
3636 Georgia Avenue NW
Washington, DC 20010
Grant Number
H89HA00012
Participating Start Date
8/16/2022
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #3047
8601 MARTIN LUTHER KING JR HIGHWAY
LANHAM, MD 20706
Pharmacy Comments
Contract Details
Approval Date
7/26/2022
Contract Begin Date
8/16/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DeMarc Anthony Hickson, Executive Director
(202) 446-1100 Ext: 1092
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2022
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