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MARYLAND CVS PHARMACY, L.L.C.
DSH210043 BALTIMORE WASHINGTON MEDICAL CENTER
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Covered Entity Details
Entity Name
BALTIMORE WASHINGTON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210043
Entity Address
301 HOSPITAL DRIVE
GLEN BURNIE, MD 21061
Medicare Provider Number
210043
Participating Start Date
1/1/2025
Last Recertification Date
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01510
2600 ANNAPOLIS RD.
SEVERN, MD 21144
Pharmacy Comments
Contract Details
Approval Date
8/6/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
William Brett McCone, SVP, Finance
(410) 787-4529
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2024
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