Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
DSH090011 MEDSTAR WASHINGTON HOSPITAL CENTER

Covered Entity Details

Entity Name

MEDSTAR WASHINGTON HOSPITAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH090011

Entity Address

110 IRVING STREET, NW
WASHINGTON, DC 20010

Medicare Provider Number

090011

Participating Start Date

1/1/2005

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 03789
4840 MARLBORO PIKE
CAPITOL HEIGHTS, MD 20743

Pharmacy Comments

Contract Details

Approval Date

1/23/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/30/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Catherine Monge, Sr Vice President Operations
(202) 877-7454

Contract Pharmacy Representative

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

Signed By Date

1/23/2017

340B Drug Pricing Program Database