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MARYLAND CVS PHARMACY, L.L.C.
DSH090011 MEDSTAR WASHINGTON HOSPITAL CENTER
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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 # 01477
1290 EAST-WEST HIGHWAY
SILVER SPRING, MD 20910
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Scott Dubin, Chief Medical Officer
(202) 877-6038
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2024
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