Contract Pharmacy Details

WALGREEN CO.
DSH210002 UNIVERSITY OF MARYLAND MEDICAL CENTER

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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 05408
1300 EAST NORTH AVE
BALTIMORE, MD 21213-1406

Pharmacy Comments

Contract Details

Approval Date

4/10/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/13/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

JEFFREY RIVEST, President and Chief Executive Officer
(410) 328-0313

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/10/2014

340B Drug Pricing Program Database