Covered Entity Details

CH01199F BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. (Terminated) - information as of 6/4/2025 12:07:54 PM

Main Details

Name

BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.

Subdivision Name

BVCHC Women's Health, Vision, and Specialty Services

Type

HRSA-Funded Health Center

Site ID

BPS-H80-017775

340B ID

CH01199F

Grant Number

H80CS00154

Additional Details

Current Program Status

Terminated

Registration Date

7/1/2016

Participating Start Date

10/1/2016

Participating Approval Date

7/26/2016

Last Recertification Date

1/31/2019

Termination Date
Termination Reason

4/1/2020
Business decision by the Covered Entity

Contacts

Authorizing Official

BVCHC, Inc.
Raymond Joseph Lavoie, EXECUTIVE DIRECTOR
(401) 729-5235

Primary Contact

Blackstone Valley Community Health Care
Sandra Pardus, CFO
(401) 729-0080 Ext: 115

Addresses

Street Address

42 Park Pl
Pawtucket, RI 02860-4010

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH011990	Active	BPS-H80-012175	BLACKSTONE VALLEY COMMUNITY HEALTH CARE	Blackstone Valley Community Health Care	39 EAST AVENUE	PAWTUCKET	RI
CH01199A	Active	BPS-H80-004244	BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC	BLACKSTONE VALLEY COMM HLTH CTR	9 CHESTNUT ST	CENTRAL FALLS	RI
CH01199B	Active	BPS-H80-005265	BLACKSTONE VALLEY COMMUNITY HEALTH CARE INC	BVCHC DENTAL & WIC SVS	210 Main St	Pawtucket	RI
CH01199C	Active	BPS-H80-003915	BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.	CENTRAL FALLS HIGH SCHOOL CLINIC	24 SUMMER ST	CENTRAL FALLS	RI
CH01199D	Active	BPS-H80-017439	BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.	BVCHC Main Street Satellite	1145 MAIN ST	PAWTUCKET	RI
CH01199E	Active	BPS-H80-017407	BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.	BVCHC Central Falls	1000 Broad Street	Central Falls	RI
CH01199F	Terminated	BPS-H80-017775	BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.	BVCHC Women's Health, Vision, and Specialty Services	42 Park Pl	Pawtucket	RI

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH011990	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	10/01/2020
CH011990	BLACKSTONE HEALTH MART PHARMACY	GARY S KISHFY	465 LONSDALE AVE SUITE B	PAWTUCKET	RI	02860-0286	11/14/2008	04/10/2016
CH011990	BLACKSTONE PHARMACY		38 EAST AVE	PAWTUCKET	RI	02860-4004	07/01/2013	03/14/2016
CH011990	BLACKSTONE VALLEY COMMUNITY PHARMACY	39 EAST AVENUE	SUITE 100	PAWTUCKET	RI	02860-4003	04/01/2017	04/01/2022
CH011990	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	10/01/2020
CH011990	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/01/2020
CH011990	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/01/2020
CH011990	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/01/2020
CH011990	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	10/01/2020
CH011990	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/01/2020
CH011990	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	10/01/2020
CH011990	CAREMARK PUERTO RICO SPECIALTY PHARMACY,	CAREMARK PUERTO RICO SPECIALTY PHARMACY	6020 AVE ROBERTO SANCHEZ VILELLA	CAROLINA	PR	00982	10/01/2020	02/26/2021
CH011990	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	10/01/2020
CH011990	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	10/01/2020
CH011990	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2020
CH011990	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2020
CH011990	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2019
CH011990	HOWELL SMITH DRUGGIST	749 CENTRAL AVE		PAWTUCKET	RI	02861-0286	07/01/2014	03/14/2016
CH011990	MAXI DRUG SOUTH, LP	RITE AID #10230	1114 BROAD STREET	CENTRAL FALLS	RI	02863	07/01/2015	01/18/2018
CH011990	MAXI DRUG SOUTH, LP	RITE AID #10228	150 MINERAL SPRING AVE.	PAWTUCKET	RI	02860	07/01/2015	01/01/2017
CH011990	MAXI DRUG SOUTH, LP	RITE AID #10227	342 POWER ROAD	PAWTUCKET	RI	02860	07/01/2015	01/18/2018
CH011990	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/01/2019	10/01/2022
CH011990	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/01/2020
CH011990	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	10/01/2020
CH011990	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	10/01/2020
CH011990	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04096	309 BROAD ST.	CENTRAL FALLS	RI	02863	07/01/2018
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00670	601 SMITHFIELD AVENUE	PAWTUCKET	RI	02860	01/01/2019
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00728	315 BROAD ST,	CUMBERLAND	RI	02864	01/01/2019
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01042	835 NEWPORT AVE.	PAWTUCKET	RI	02861	01/01/2019
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02234	425 EAST AVENUE	PAWTUCKET	RI	02860	01/01/2019
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07387	63 NEWPORT AVE	RUMFORD	RI	02916	01/01/2019
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY #11234	1000 BROAD ST.	CENTRAL FALLS	RI	02863	07/01/2019	01/14/2022
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00326	120 EDDIE DOWLING HWY.	NORTH SMITHFIELD	RI	02896	07/01/2019
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01075	20 HIGH STREET	PASCOAG	RI	02859	07/01/2019
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00351	1919 MINERAL SPRING AVENUE	NORTH PROVIDENCE	RI	02904	01/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00590	1054 CASS AVENUE	WOONSOCKET	RI	02895	01/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00856	400 ADMIRAL STREET	PROVIDENCE	RI	02908	01/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02347	640 WARREN AVENUE	EAST PROVIDENCE	RI	02914	01/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02384	834 PROVIDENCE STREET	WEST WARWICK	RI	02893	01/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00729	799 HOPE STREET	PROVIDENCE	RI	02906	10/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04796	960 BROAD STREET	PROVIDENCE	RI	02905	10/01/2020
CH011990	RHODE ISLAND CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02417	935 MANTON AVENUE	PROVIDENCE	RI	02909	10/01/2020
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03204	295 ACADEMY AVENUE	PROVIDENCE	RI	02908	07/01/2015
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03468	100 BROAD ST	PAWTUCKET	RI	02860	07/01/2015
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10256	1140 N. MAIN ST.	PROVIDENCE	RI	02904-1819	07/01/2015
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #13987	385 COTTAGE ST.	PAWTUCKET	RI	02861-1603	07/01/2015
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03737	1074 MINERAL SPRING AVE.	NORTH PROVIDENCE	RI	02904-4104	01/01/2017
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04145	533 ELMWOOD AVE.	PROVIDENCE	RI	02907	04/01/2017
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03703	354 ADMIRAL STREET	PROVIDENCE	RI	02908	04/01/2018
CH011990	WALGREEN EASTERN CO., INC.	RITE AID #10230	1114 BROAD ST.	CENTRAL FALLS	RI	02863	02/01/2018	02/26/2019
CH011990	WALGREEN EASTERN CO., INC.	RITE AID #10227	342 POWER RD.	PAWTUCKET	RI	02860	02/01/2018	03/25/2019
CH011990	WALGREEN EASTERN CO., INC.	RITE AID #10229	727 EAST AVE.	PAWTUCKET	RI	02860	07/01/2018	02/19/2019
CH011990	WALGREEN EASTERN CO., INC.	WALGREENS #18384	456 BRANCH AVE.	PROVIDENCE	RI	02904-2205	07/01/2019	11/10/2022
CH011990	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15538	335 PRAIRIE AVENUE	PROVIDENCE	RI	02905	07/01/2021
CH011990	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/01/2023
CH011990	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	07/01/2019	10/01/2021
CH011990	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2019
CH011990	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2019
CH011990	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		1/31/2020 12:00:00 AM	2/5/2020 11:18 AM
Details	State	Update	Recertification	Active	To Be Terminated	2/5/2020 11:18 AM
Terminations	Termination Comments	Update	Recertification		Optometry Services were offered at this site. Optometry services were moved to our new facility at 1000 Broad St., Central Falls, RI on 1/31/2020. This site is now an admin-only site.	2/5/2020 11:18 AM
Terminations	Termination Date	Update	Recertification		4/1/2020 12:00:00 AM	2/5/2020 11:18 AM
Terminations	Termination Effective Date	Update	Recertification		2/3/2020 12:00:00 AM	2/5/2020 11:18 AM
Terminations	Termination Reason	Update	Recertification		Business decision by the Covered Entity	2/5/2020 11:18 AM
Details	Last Recertification Date	Update	Recertification	2/9/2018 2:30:54 PM	1/31/2019 4:56:15 AM	1/31/2019 4:56 AM
Details	Last Recertification Date	Update	Recertification	2/1/2017 12:00:00 AM	2/9/2018 2:30:54 PM	2/9/2018 2:30 PM
Contacts	Authorizing Official	Update		Lavoie, Raymond EXECUTIVE DIRECTOR 4017295235	Lavoie, Raymond Joseph EXECUTIVE DIRECTOR BVCHC, Inc. 4017295235	9/29/2017 9:47 AM
Contacts	Signed By	Update		Lavoie, Raymond EXECUTIVE DIRECTOR 4017295235	Lavoie, Raymond Joseph EXECUTIVE DIRECTOR BVCHC, Inc. 4017295235	9/29/2017 9:47 AM
Contacts	Primary Contact	Update		Pardus, Sandra CFO 4017290080-115	Pardus, Sandra CFO Blackstone Valley Community Health Care 4017290080-115	9/19/2017 7:49 AM
Contacts	Authorizing Official	Insert			Lavoie, Raymond EXECUTIVE DIRECTOR 4017295235	4/29/2017 7:50 PM
Contacts	Signed By	Insert			Lavoie, Raymond EXECUTIVE DIRECTOR 4017295235	4/29/2017 7:50 PM
Contacts	Primary Contact	Insert			Pardus, Sandra CFO 4017290080-115	4/29/2017 7:50 PM
Addresses	Main Address	Insert			42 Park Pl Pawtucket, RI 02860-4010	2/1/2017 2:37 PM
Details	Last Recertification Date	Update			2/1/2017 12:00:00 AM	2/1/2017 2:36 PM
Dates	Participating Approval Date	Update			7/26/2016 12:00:00 AM	7/26/2016 5:38 PM
Details	State	Update		Pending	Active	7/26/2016 5:38 PM
Dates	Start Date	Update			10/1/2016 12:00:00 AM	7/26/2016 5:38 PM
Details	340B ID	Update		ONLINE_REG_60762	CH01199F	7/22/2016 10:51 AM
Details	Entity Subname	Update		BVCHC Women&s Health, Vision, and Specialty Services	BVCHC Women's Health, Vision, and Specialty Services	7/22/2016 10:51 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_60762	7/1/2016 10:41 AM
Details	Last Recertification Date	Insert				7/1/2016 10:41 AM
Details	Grant Number	Insert			H80CS00154	7/1/2016 10:41 AM
Details	340B ID	Insert			ONLINE_REG	7/1/2016 10:41 AM
Details	Is Authorizing Official EHB Data	Insert			False	7/1/2016 10:41 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/1/2016 10:41 AM
Details	Medicare Provider Number	Insert				7/1/2016 10:41 AM
Details	Entity Name	Insert			BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC.	7/1/2016 10:41 AM
Details	Program Code	Insert			CH	7/1/2016 10:41 AM
Details	Entity Subname	Insert			BVCHC Women&s Health, Vision, and Specialty Services	7/1/2016 10:41 AM
Dates	Participating Approval Date	Insert				7/1/2016 10:41 AM
Details	State	Insert			Pending	7/1/2016 10:41 AM
Dates	Registration Date	Insert			7/1/2016 12:00:00 AM	7/1/2016 10:41 AM
Dates	Signed By Date	Insert			7/1/2016 12:00:00 AM	7/1/2016 10:41 AM
Dates	Start Date	Insert				7/1/2016 10:41 AM
Terminations	Termination Comments	Insert				7/1/2016 10:41 AM
Terminations	Termination Date	Insert				7/1/2016 10:41 AM
Terminations	Termination Effective Date	Insert				7/1/2016 10:41 AM
Terminations	Termination Reason	Insert				7/1/2016 10:41 AM

340B Drug Pricing Program Database