Contract Pharmacy Details

VIRGINIA CVS PHARMACY, L.L.C.
DSH490022 MARY WASHINGTON HOSPITAL

Covered Entity Details

Entity Name

MARY WASHINGTON HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH490022

Entity Address

1001 SAM PERRY BLVD
FREDERICKSBURG, VA 22401

Medicare Provider Number

490022

Participating Start Date

7/1/2024

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

VIRGINIA CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 16398
46201 POTOMAC RUN PLZ
STERLING, VA 20164

Pharmacy Comments

Contract Details

Approval Date

7/10/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Sean Timothy Barden, Executive VP & CFO
(540) 741-1494

Contract Pharmacy Representative

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

Signed By Date

7/10/2024

340B Drug Pricing Program Database