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CH01058J PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE (Terminated)
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Main Details
Name
PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE
Subdivision Name
THE METROPOLITAN SHC
Type
HRSA-Funded Health Center
Site ID
BPS-H80-006210
340B ID
CH01058J
Grant Number
H80CS00057
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2004
Participating Start Date
4/1/2004
Participating Approval Date
3/25/2004
Last Recertification Date
2/1/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
PCHC
MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130
Primary Contact
Providence Community Health Centers
Garrett Clark, CO
(401) 444-0400
Addresses
Street Address
325 PUBLIC ST
PROVIDENCE, RI 02905-2340
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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NEW SITE 04/01/2004
04/01/2004
April 2025
April 2025
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