Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
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

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04079
5603 BALTIMORE NATIONAL PIKE
BALTIMORE, MD 21228

Pharmacy Comments

Contract Details

Approval Date

4/8/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Keith D. Persinger, Executive Vice President – Chief Operating & Financial Officer
(410) 328-1382

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/8/2016

340B Drug Pricing Program Database