Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
DSH210009 JOHNS HOPKINS HOSPITAL

Covered Entity Details

Entity Name

JOHNS HOPKINS HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210009

Entity Address

600 NORTH WOLFE STREET
BALTIMORE, MD 21287

Medicare Provider Number

210009

Participating Start Date

7/1/2002

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07952
630 EXETER ST.
BALTIMORE, MD 21202

Pharmacy Comments

Contract Details

Approval Date

7/16/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

RONALD J. WERTHMAN, CFO
(410) 735-6505

Contract Pharmacy Representative

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

Signed By Date

7/16/2015

340B Drug Pricing Program Database