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RITE AID OF MARYLAND, INC.
DSH210002 UNIVERSITY OF MARYLAND MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF MARYLAND MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210002
Entity Address
22 SOUTH GREENE STREET
BALTIMORE, MD 21201
Medicare Provider Number
210002
Participating Start Date
10/1/2001
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MARYLAND, INC.
Pharmacy Address
RITE AID #4295
250 WEST CHASE STREET
BALTIMORE, MD 21202
Pharmacy Comments
Contract Details
Approval Date
4/4/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JEFFREY RIVEST, President and Chief Executive Officer
(410) 328-0313
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/4/2014
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