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MARYLAND CVS PHARMACY, L.L.C.
DSH210038 MARYLAND GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MARYLAND GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210038
Entity Address
827 LINDEN AVENUE
BALTIMORE, MD 21201
Medicare Provider Number
210038
Participating Start Date
4/1/2016
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04079
5603 BALTIMORE NATIONAL PIKE
BALTIMORE, MD 21228
Pharmacy Comments
Contract Details
Approval Date
4/4/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Dicubellis, Senior Director of Pharmacy
(410) 328-6746
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/4/2024
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