Contract Pharmacy Details

AMAZON PHARMACY #001
CH010580 PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Covered Entity Details

Entity Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Subdivision Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC.

Type

HRSA-Funded Health Center

340B ID

CH010580

Entity Address

375 Allens Ave
Providence, RI 02905-5010

Grant Number

H80CS00057

Participating Start Date

7/1/1996

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

AMAZON PHARMACY #001

Pharmacy Address

4500 S PLEASANT VALLEY RD STE 201
AUSTIN, TX 78744-2911

Pharmacy Comments

Contract Details

Approval Date

1/15/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130

Contract Pharmacy Representative

PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725

Signed By Date

1/15/2019

340B Drug Pricing Program Database