340B Drug Pricing Program Database
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MARYLAND CVS PHARMACY, L.L.C.
DSH210008 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210008
Entity Address
345 ST. PAUL PLACE
BALTIMORE, MD 21202
Medicare Provider Number
210008
Participating Start Date
10/1/2002
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02522
3300 BELAIR RD.
BALTIMORE, MD 21213
Pharmacy Comments
Contract Details
Approval Date
10/14/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Morrell Delcher, VP & Chief Pharmacy Officer
(410) 332-9627
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2015
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