Contract Pharmacy Details

MARYLAND CVS PHARMACY, L.L.C.
DSH210029 JOHNS HOPKINS BAYVIEW MEDICAL CENTER

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

MARYLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04429
7845 WISE AVE.
BALTIMORE, MD 21222

Pharmacy Comments

Contract Details

Approval Date

7/22/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/24/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

RICHARD G BENNETT, President
(410) 550-0781

Contract Pharmacy Representative

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

Signed By Date

7/22/2015

340B Drug Pricing Program Database