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LUTHERVILLE PHARMACY
CH030130 PARK WEST HEALTH SYSTEMS INCORPORATED
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Covered Entity Details
Entity Name
PARK WEST HEALTH SYSTEMS INCORPORATED
Subdivision Name
PARK WEST MEDICAL CENTER - BELVEDERE
Type
HRSA-Funded Health Center
340B ID
CH030130
Entity Address
3319 W Belvedere Ave
Baltimore, MD 21215-5143
Grant Number
H80CS00067
Participating Start Date
12/1/1992
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
LUTHERVILLE PHARMACY
Pharmacy Address
1776 YORK RD
LUTHERVILLE, MD 21093
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALLEN J. BENNETT, PRESIDENT & CEO
(410) 542-7800 Ext: 7501
Contract Pharmacy Representative
Park West Health System, Inc.
ALLEN J. BENNETT, PRESIDENT & CEO
(410) 542-7800 Ext: 7501
Signed By Date
4/17/2023
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