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WIENNER
RWI212015 University of Maryland
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Covered Entity Details
Entity Name
University of Maryland
Subdivision Name
Adolescent Star Track
Type
Ryan White Part A
340B ID
RWI212015
Entity Address
737 Lombard Street
Baltimore, MD 21201
Grant Number
H89HA000017
Participating Start Date
1/1/2013
Last Recertification Date
2/12/2025
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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