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MARYLAND CVS PHARMACY, L.L.C.
DSH210034 HARBOR HOSPITAL INC.
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Covered Entity Details
Entity Name
HARBOR HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210034
Entity Address
3001 SOUTH HANOVER STREET
BALTIMORE, MD 21225
Medicare Provider Number
210034
Participating Start Date
10/1/2003
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04418
8501 FORT SMALLWOOD RD.
PASADENA, MD 21122
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert P. Lally Jr., CFO
(443) 777-7257
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/17/2017
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