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MARYLAND CVS PHARMACY, L.L.C.
CH03682C LA CLINICA DEL PUEBLO, INC
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Covered Entity Details
Entity Name
LA CLINICA DEL PUEBLO, INC
Subdivision Name
Vansville Elementary School
Type
HRSA-Funded Health Center
340B ID
CH03682C
Entity Address
6813 Ammendale Road
Beltsville, MD 20705-1243
Grant Number
H80CS08244
Participating Start Date
7/1/2024
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01486
5621 SARGENT ROAD
HYATTSVILLE, MD 20782
Pharmacy Comments
Contract Details
Approval Date
5/24/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carlos Plazas, CFO/COO
(202) 464-0141
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
5/24/2024
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