Contract Pharmacy Details

DELMARVA PHARMACY #2
CH03301H THREE LOWER COUNTIES COMMUNITY SERVICES, INC.

Covered Entity Details

Entity Name

THREE LOWER COUNTIES COMMUNITY SERVICES, INC.

Subdivision Name

THREE LOWER COUNTIES COMMUNITY SVCS INC

Type

HRSA-Funded Health Center

340B ID

CH03301H

Entity Address

12145 Elm St
Princess Anne, MD 21853-1358

Grant Number

H80CS00774

Participating Start Date

4/1/2007

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

DELMARVA PHARMACY #2

Pharmacy Address

THREE LOWER COUNTIES COMMUNITY SERVICES,
12137 ELM ST
PRINCESS ANNE, MD 21853

Pharmacy Comments

Contract Details

Approval Date

7/3/2014

Contract Begin Date

10/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Susanne Gray, CEO/President
(410) 749-1015

Contract Pharmacy Representative

Shawn Eisemann, Director of Pharmacy
(410) 651-1000

Signed By Date

7/3/2014

340B Drug Pricing Program Database