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BROWN UNIVERSITY HEALTH PHARMACY NO 003
TB02906 The Miriam Hospital
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Covered Entity Details
Entity Name
The Miriam Hospital
Subdivision Name
RISE TB Clinic
Type
Tuberculosis
340B ID
TB02906
Entity Address
14 Third St.
Providence, RI 02906
Grant Number
NU52PS910201
Participating Start Date
1/1/2015
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
BROWN UNIVERSITY HEALTH PHARMACY NO 003
Pharmacy Address
180 CORLISS ST STE A
PROVIDENCE, RI 02904
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Wakefield, Senior VP and CFO
(401) 444-7093
Contract Pharmacy Representative
Brown University Health
CHRISTINE COLLINS, SVP, Pharmacy & Periop, Chief Pharmacy Officer
(401) 444-4434
Signed By Date
7/11/2019
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