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WALGREEN CO.
DSH210002 UNIVERSITY OF MARYLAND MEDICAL CENTER
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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
WALGREEN CO.
Pharmacy Address
RITE AID #00366
2497 FREDERICK AVE
BALTIMORE, MD 21223
Pharmacy Comments
Contract Details
Approval Date
4/9/2018
Contract Begin Date
4/9/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/16/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Keith D. Persinger, Executive Vice President – Chief Operating & Financial Officer
(410) 328-1382
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/9/2018
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