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WIENNER
FP212012 UNIVERSITY OF MARYLAND
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Covered Entity Details
Entity Name
UNIVERSITY OF MARYLAND
Subdivision Name
Community Pediatrics and Adolescent Medicine
Type
Family Planning (Title X only)
340B ID
FP212012
Entity Address
120 PENN STREET AYAC CLINIC
BALTIMORE, MD 21201
Grant Number
FPHPA036069
Participating Start Date
4/1/2004
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
WIENNER
Pharmacy Address
MT. VERNON PHARMACY
900 CATHEDRAL ST
MT VERNON PHARMACY
BALTIMORE, MD 21201-5311
Pharmacy Comments
Contract Details
Approval Date
10/9/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Vicki Tepper, CHIEF, DIVISION OF ADOLESCENT & YOUNG ADULT MEDICINE
(410) 706-8931
Contract Pharmacy Representative
Weinner, Inc
Stephen Wienner, Owner
(410) 539-8030
Signed By Date
10/9/2024
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