Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
CHC26633-01 Owensville Primary Care, Inc.

Covered Entity Details

Entity Name

Owensville Primary Care, Inc.

Subdivision Name

Owensville Primary Care, Inc.

Type

HRSA-Funded Health Center

340B ID

CHC26633-01

Entity Address

134 Owensville Rd
West River, MD 20778-9998

Grant Number

H80CS26633

Participating Start Date

10/1/2022

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02221
3715 UNIVERSITY BOULEVARD WEST
KENSINGTON, MD 20895

Pharmacy Comments

Contract Details

Approval Date

8/25/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/26/2022
Agreement registered in error

Contacts

Covered Entity Signing Official

Juanita M Tryon, Chief Executive Officer
(443) 607-1438

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/16/2022

340B Drug Pricing Program Database