Covered Entity Details

DSH410007AC RHODE ISLAND HOSPITAL (Active) - information as of 5/2/2025 10:35:37 PM

Main Details

Name

RHODE ISLAND HOSPITAL

Subdivision Name

RIH East Providence Infusion Services

Type

Disproportionate Share Hospital

Rural

340B ID

DSH410007AC

Medicare Provider Number

410007

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/6/2017

Participating Start Date

7/1/2017

Participating Approval Date

5/10/2017

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Brown University Health
Michael D Dawson, VP Finance
(401) 444-2648

Primary Contact

Brown University Health
CHRISTINE COLLINS, SVP, Pharmacy & Periop, Chief Pharmacy Officer
(401) 444-4434

Addresses

Street Address

375 Wampanoag Trail
Suite 101A
East Providence, RI 02915

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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?
Yes

State	Medicaid Number	NPI Number
MA	110066635A,110066635B	1588659528
RI	OP00007	1588659528

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH410007A	Child	DSH	RHODE ISLAND HOSPITAL	Dialysis Center of RI Hospital	117 Chapman St	Providence	RI	Active
DSH410007AA	Child	DSH	RHODE ISLAND HOSPITAL	Neuro Rehab Services	765 Allens Avenue Suite 200	Providence	RI	Active
DSH410007AB	Child	DSH	RHODE ISLAND HOSPITAL	RIH Rheumatology Infusion	407 East Avenue Suite 200	Pawtucket	RI	Active
DSH410007AC	Child	DSH	RHODE ISLAND HOSPITAL	RIH East Providence Infusion Services	375 Wampanoag Trail	East Providence	RI	Active
DSH410007AD	Child	DSH	RHODE ISLAND HOSPITAL	LIFESPAN RECOVERY CENTER - TREATMENT CLINIC	200 CORLISS STREET	PROVIDENCE	RI	Active
DSH410007AE	Child	DSH	RHODE ISLAND HOSPITAL	Adolescent Center EP - Clinic	900 Warren Avenue	East Providence	RI	Active
DSH410007AF	Child	DSH	RHODE ISLAND HOSPITAL	Sleep Disorder Center EP - Pulmonary Function Testing	70 Catamore Boulevard	East Providence	RI	Active
DSH410007AG	Child	DSH	RHODE ISLAND HOSPITAL	Cardio / Pulm Center EG - Clinic	1454 South County Trail	East Greenwich	RI	Active
DSH410007AH	Child	DSH	RHODE ISLAND HOSPITAL	Adolescent Medicine EG - Primary Care Clinic	1454 South County Trail	East Greenwich	RI	Active
DSH410007AJ	Child	DSH	RHODE ISLAND HOSPITAL	East Greenwich Center - Clinic	1454 South County Trail	East Greenwich	RI	Active
DSH410007AK	Child	DSH	RHODE ISLAND HOSPITAL	Pediatric Specialties EP - Clinic	900 Warren Ave	East Providence	RI	Active
DSH410007AL	Child	DSH	RHODE ISLAND HOSPITAL	Pediatric GI Clinic EG - Clinic	1454 South County Trail	East Greenwich	RI	Active
DSH410007AM	Child	DSH	RHODE ISLAND HOSPITAL	Pediatric GI Clinic EP - Clinic	900 Warren Avenue	East Providence	RI	Active
DSH410007AN	Child	DSH	RHODE ISLAND HOSPITAL	Occupational Therapy - Occupational Therapy	235 Plain Street	Providence	RI	Active
DSH410007AP	Child	DSH	RHODE ISLAND HOSPITAL	Norman Prince Spine Institute	690 Eddy Street	Providence	RI	Active
DSH410007AQ	Child	DSH	RHODE ISLAND HOSPITAL	Families First/CEDARR - Pediatrics	335R Prairie Ave	Providence	RI	Active
DSH410007AR	Child	DSH	RHODE ISLAND HOSPITAL	Pedi Palliative Care / Pain - Pediatrics	765 Allens Avenue	Providence	RI	Active
DSH410007AS	Child	DSH	RHODE ISLAND HOSPITAL	Allergy Pulmonary Center - Clinic	900 Warren Avenue	East Providence	RI	Active
DSH410007AT	Child	DSH	RHODE ISLAND HOSPITAL	Pediatric Specialties EG - Clinic	1454 South County Trail	East Greenwich	RI	Active
DSH410007AU	Child	DSH	RHODE ISLAND HOSPITAL	Rehab East Greenwich - Clinic	1454 South County Trail	East Greenwich	RI	Active
DSH410007AV	Child	DSH	RHODE ISLAND HOSPITAL	Wound Care & Hyperbaric Center - Clinic	950 Warren Avenue	East Providence	RI	Active
DSH410007AW	Child	DSH	RHODE ISLAND HOSPITAL	RIH LINCOLN INFUSION CENTER - ONCOLOGY	701 George Washington Hwy	LINCOLN	RI	Active
DSH410007AX	Child	DSH	RHODE ISLAND HOSPITAL	ALLERGY/PULMONARY CTR - PULMONARY	1454 SOUTH COUNTY TRAIL	EAST GREENWICH	RI	Active
DSH410007AY	Child	DSH	RHODE ISLAND HOSPITAL	Pediatric Sleep Lab	1407 South County Trail	East Greenwich	RI	Active
DSH410007AZ	Child	DSH	RHODE ISLAND HOSPITAL	EEG Neuro Laboratory	1407 South County Trail	East Greenwich	RI	Terminated
DSH410007B	Child	DSH	RHODE ISLAND HOSPITAL	Pediatric Physical Therapy	765 Allens Avenue	Providence	RI	Terminated
DSH410007BA	Child	DSH	RHODE ISLAND HOSPITAL	HCH Complex Care Clinic - Clinic	2 Dudley St	Providence	RI	Active
DSH410007BB	Child	DSH	RHODE ISLAND HOSPITAL	GENETIC CLINIC - GENETIC CLINIC	111 Plain ST FL2	Providence	RI	Active
DSH410007BC	Child	DSH	RHODE ISLAND HOSPITAL	RIH WEST RIVER INFUSION CTR - RIH WEST RIVER INFUSION CTR	148 West River Street STE 2B	Providence	RI	ToBeTerminated
DSH410007BD	Child	DSH	RHODE ISLAND HOSPITAL	RIH CPC Psychiatry - Psychiatry	245 Chapman Street	Providence	RI	Approved
DSH410007BE	Child	DSH	RHODE ISLAND HOSPITAL	RIH Adult GI - Specialty Clinic	245 Chapman Street	Providence	RI	Approved
DSH410007BF	Child	DSH	RHODE ISLAND HOSPITAL	RIH CVI West River - Center for Advanced Lung Care	146 West River Street	Providence	RI	Approved
DSH410007BG	Child	DSH	RHODE ISLAND HOSPITAL	RIH Adult IBD - Specialty Clinic	245 Chapman Street	Providence	RI	Approved
DSH410007BH	Child	DSH	RHODE ISLAND HOSPITAL	RIH Calc Pulmonary - Center for Advanced Lung Care	146 West River Street	Providence	RI	Approved
DSH410007C	Child	DSH	RHODE ISLAND HOSPITAL	Audiology / Speech Pathology	115 Georgia Avenue	Providence	RI	Active
DSH410007D	Child	DSH	RHODE ISLAND HOSPITAL	Hallett Center	900 Warren Avenue	East Providence	RI	Terminated
DSH410007E	Child	DSH	RHODE ISLAND HOSPITAL	Adolescent Health	1 Hoppin Street	Providence	RI	Active
DSH410007F	Child	DSH	RHODE ISLAND HOSPITAL	Diabetes and Endocrinolgy	111 Plain St.	Providence	RI	Active
DSH410007G	Child	DSH	RHODE ISLAND HOSPITAL	Occupational Therapy	765 Allens Avenue	Providence	RI	Active
DSH410007H	Child	DSH	RHODE ISLAND HOSPITAL	Physical Therapy ( Adult )	765 Allens Avenue	Providence	RI	Active
DSH410007J	Child	DSH	RHODE ISLAND HOSPITAL	Electrocardiology Lab ( Stress Lab )	1 Hoppin Street	Providence	RI	Terminated
DSH410007K	Child	DSH	RHODE ISLAND HOSPITAL	Eye Clinic	1 Hoppin Street	Providence	RI	Terminated
DSH410007L	Child	DSH	RHODE ISLAND HOSPITAL	MED/PEDS Program	245 Chapman Street	Providence	RI	Active
DSH410007M	Child	DSH	RHODE ISLAND HOSPITAL	Center for Special Children	335 R Prairie Ave	Providence	RI	Active
DSH410007N	Child	DSH	RHODE ISLAND HOSPITAL	Medical Primary Care Clinic	245 Chapman Street	Providence	RI	Active
DSH410007P	Child	DSH	RHODE ISLAND HOSPITAL	EP Outpatient Dialysis	950 Warren Avenue	East Providence	RI	Active
DSH410007Q	Child	DSH	RHODE ISLAND HOSPITAL	Cancer Center at NH	11 Friendship Street	Newport	RI	Active
DSH410007R	Child	DSH	RHODE ISLAND HOSPITAL	East Greenwich Cancer Center	1454 S. County Trail	East Greenwich	RI	Active
DSH410007S	Child	DSH	RHODE ISLAND HOSPITAL	Cancer Center at TMH	164 Summit Street	PROVIDENCE	RI	Active
DSH410007T	Child	DSH	RHODE ISLAND HOSPITAL	Medical Specialty Clinic	245 Chapman Street	PROVIDENCE	RI	Active
DSH410007U	Child	DSH	RHODE ISLAND HOSPITAL	Child Protection Clinic (Hasbro)	1 Hoppin St., Rm 3055	Providence	RI	Terminated
DSH410007V	Child	DSH	RHODE ISLAND HOSPITAL	Pediatric Cardiolgy Center (Hasbro)	1 Hoppin St., Rm 304A	Providence	RI	Active
DSH410007W	Child	DSH	RHODE ISLAND HOSPITAL	Cardio-Pulmonary Lab. (Hasbro)	1 Hoppin St., Rm. 304	Providence	RI	Active
DSH410007X	Child	DSH	RHODE ISLAND HOSPITAL	Children's Rehab. Services	765 Allen Ave., Suite 200	Providence	RI	Active
DSH410007Z	Child	DSH	RHODE ISLAND HOSPITAL	Wayland Square Surgical Center	17 Seekonk St	Providence	RI	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	AO Change Request	Greenwood, Eva Senior VP Finance Lifespan 4014442221	Dawson, Michael D VP Finance Brown University Health 4014442648	12/4/2024 7:36 AM
Contacts	Primary Contact	Update	Profile Change Request	COLLINS, CHRISTINE Vice President and Chief Pharmacy Officer Lifespan 4014444434	COLLINS, CHRISTINE SVP, Pharmacy & Periop, Chief Pharmacy Officer Brown University Health 4014444434	11/15/2024 11:13 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 10:38:53 AM	8/20/2024 12:09:35 PM	8/20/2024 12:09 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 9:53:52 AM	8/16/2023 10:38:53 AM	8/16/2023 10:38 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/10/2023 2:16 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		110066635A	3/10/2023 2:16 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MA	3/10/2023 2:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/10/2023 2:16 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		110066635B	3/10/2023 2:16 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		MA	3/10/2023 2:16 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1588659528	3/10/2023 2:16 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		MA	3/10/2023 2:16 PM
Contacts	Authorizing Official	Update	AO Change Request	Kirshner, David Executive Vice President and Chief Financial Officer Lifespan 4014447093	Greenwood, Eva Senior VP Finance Lifespan 4014442221	1/11/2023 6:45 AM
Details	Last Recertification Date	Update	Recertification	8/25/2021 2:12:06 PM	9/7/2022 9:53:52 AM	9/7/2022 9:53 AM
Contacts	Authorizing Official	Update	Change Request	Wakefield, Mary Senior VP and CFO Rhode Island Hospital 4014447093	Kirshner, David Executive Vice President and Chief Financial Officer Lifespan 4014447093	10/4/2021 11:22 AM
Details	Last Recertification Date	Update	Recertification	8/20/2020 2:33:33 PM	8/25/2021 2:12:06 PM	8/25/2021 2:12 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1588659528	8/20/2020 2:33 PM
Medicaid Billing	NPI: State	Insert	Recertification		RI	8/20/2020 2:33 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1588659528 ( )		8/20/2020 2:33 PM
Details	Last Recertification Date	Update	Recertification	8/19/2019 10:50:26 AM	8/20/2020 2:33:33 PM	8/20/2020 2:33 PM
Contacts	Primary Contact	Update	Profile Change Request	COLLINS, CHRISTINE DIRECTOR OF PHARMACY Lifespan 4014444434	COLLINS, CHRISTINE Vice President and Chief Pharmacy Officer Lifespan 4014444434	10/3/2019 7:17 AM
Details	Last Recertification Date	Update	Recertification	8/31/2018 9:38:00 AM	8/19/2019 10:50:26 AM	8/19/2019 10:50 AM
Addresses	Main Address	Update	Change Request	375 Wampanoag Trial Suite 101A East Providence, RI 02915	375 Wampanoag Trail Suite 101A East Providence, RI 02915	7/16/2019 12:08 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 1:05:17 PM	8/31/2018 9:38:00 AM	8/31/2018 9:38 AM
Contacts	Primary Contact	Insert	Recertification		COLLINS, CHRISTINE DIRECTOR OF PHARMACY Lifespan 4014444434	11/10/2017 1:05 PM
Details	Last Recertification Date	Update	Recertification		11/10/2017 1:05:17 PM	11/10/2017 1:05 PM
Contacts	Authorizing Official	Update		Wakefield, Mary Senior VP and CFO 4014447093	Wakefield, Mary Senior VP and CFO Rhode Island Hospital 4014447093	10/4/2017 2:25 PM
Contacts	Signed By	Update		Wakefield, Mary Senior VP and CFO 4014447093	Wakefield, Mary Senior VP and CFO Rhode Island Hospital 4014447093	10/4/2017 2:25 PM
Contacts	Authorizing Official	Insert			Wakefield, Mary Senior VP and CFO 4014447093	6/30/2017 6:27 PM
Contacts	Signed By	Insert			Wakefield, Mary Senior VP and CFO 4014447093	6/30/2017 6:27 PM
Addresses	Main Address	Insert			375 Wampanoag Trial Suite 101A East Providence, RI 02915	5/10/2017 5:14 PM
Dates	Participating Approval Date	Update			5/10/2017 12:00:00 AM	5/10/2017 5:13 PM
Details	State	Update		Pending	Active	5/10/2017 5:13 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	5/10/2017 5:13 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76144	DSH410007AC	5/10/2017 3:04 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76144	4/6/2017 2:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/6/2017 2:12 PM
Medicaid Billing	Medicaid: Number	Insert			OP00007	4/6/2017 2:12 PM
Medicaid Billing	Medicaid: State	Insert			RI	4/6/2017 2:12 PM
Medicaid Billing	NPI: Number	Insert			1588659528	4/6/2017 2:12 PM
Details	Last Recertification Date	Insert				4/6/2017 2:12 PM
Details	Grant Number	Insert				4/6/2017 2:12 PM
Details	340B ID	Insert				4/6/2017 2:12 PM
Details	Is Authorizing Official EHB Data	Insert				4/6/2017 2:12 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/6/2017 2:12 PM
Details	Medicare Provider Number	Insert			410007	4/6/2017 2:12 PM
Details	Entity Name	Insert			RHODE ISLAND HOSPITAL	4/6/2017 2:12 PM
Details	Program Code	Insert			DSH	4/6/2017 2:12 PM
Details	Entity Subname	Insert			RIH East Providence Infusion Services	4/6/2017 2:12 PM
Dates	Participating Approval Date	Insert				4/6/2017 2:12 PM
Details	State	Insert			Pending	4/6/2017 2:12 PM
Dates	Registration Date	Insert			4/6/2017 12:00:00 AM	4/6/2017 2:12 PM
Dates	Signed By Date	Insert			4/6/2017 12:00:00 AM	4/6/2017 2:12 PM
Dates	Start Date	Insert				4/6/2017 2:12 PM
Terminations	Termination Comments	Insert				4/6/2017 2:12 PM
Terminations	Termination Date	Insert				4/6/2017 2:12 PM
Terminations	Termination Effective Date	Insert				4/6/2017 2:12 PM
Terminations	Termination Reason	Insert				4/6/2017 2:12 PM