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MARYLAND CVS PHARMACY, L.L.C.
STD20017 Washington Health Institute
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Covered Entity Details
Entity Name
Washington Health Institute
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD20017
Entity Address
1140 Varnum Street NE
PMB; Suite # 203
Washington, DC 20017-2153
Grant Number
1NH25PS005133-01-00
Participating Start Date
7/1/2019
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01448
8201 ANNAPOLIS RD.
NEW CARROLLTON, MD 20784
Pharmacy Comments
Contract Details
Approval Date
11/15/2022
Contract Begin Date
11/21/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Bordon, Chief Executive Officer
(240) 426-8890
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
11/15/2022
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