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MARYLAND CVS PHARMACY, L.L.C.
DSH210062 MEDSTAR SOUTHERN MARYLAND HOSPITAL C
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Covered Entity Details
Entity Name
MEDSTAR SOUTHERN MARYLAND HOSPITAL C
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210062
Entity Address
7503 SURRATTS ROAD
CLINTON, MD 20735
Medicare Provider Number
210062
Participating Start Date
10/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
MARYLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01491
8859 BRANCH AVENUE
CLINTON, MD 20735
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel M. Feeley, Interim Chief Financial Officer
(301) 877-5527
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2017
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