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MARYLAND CVS PHARMACY, L.L.C.
STD20036 Washington Health Institute
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Covered Entity Details
Entity Name
Washington Health Institute
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD20036
Entity Address
1330 New Hampshire Ave NW
Suite 121
Washington, DC 20036
Grant Number
NU62PS924632
Participating Start Date
10/1/2023
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01795
5100 BROWN STATION ROAD
UPPER MARLBORO, MD 20772
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jose Bordon, Chief Executive Officer
(240) 426-8890
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
1/15/2025
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