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WAL-MART PHARMACY 10-1893
CH033770 GREATER BADEN MEDICAL SERVICE INC
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Covered Entity Details
Entity Name
GREATER BADEN MEDICAL SERVICE INC
Subdivision Name
Greater Baden Medical Services at Brandywine
Type
HRSA-Funded Health Center
340B ID
CH033770
Entity Address
7450 Albert Road
Brandywine, MD 20613
Grant Number
H80CS00549
Participating Start Date
4/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1893
Pharmacy Address
3300 NW CRAIN HWY
BOWIE, MD 20716
Pharmacy Comments
Contract Details
Approval Date
10/16/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher A DeMarco, Chief Executive Officer
(301) 888-2233 Ext: 3306
Contract Pharmacy Representative
CVS
lyndsay Vonegosh, Account Manager
(973) 397-0981
Signed By Date
10/16/2024
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