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WALGREEN CO.
DSH210029 JOHNS HOPKINS BAYVIEW MEDICAL CENTER
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Covered Entity Details
Entity Name
JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210029
Entity Address
4940 EASTERN AVENUE
BALTIMORE, MD 21224
Medicare Provider Number
210029
Participating Start Date
10/1/2001
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 05409
4020 EASTERN AVENUE
BALTIMORE, MD 21224
Pharmacy Comments
Contract Details
Approval Date
10/29/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RICHARD G BENNETT, President
(410) 550-0781
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/29/2013
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