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ANTHONY DRUG STORES INC
CH010580 PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE
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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
ANTHONY DRUG STORES INC
Pharmacy Address
ANTHONYS DRUG
219 MANTON AVE
PROVIDENCE, RI 02909
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/26/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130
Contract Pharmacy Representative
Anthonys Drug Store
Peter Solomon, Owner
(401) 351-9507
Signed By Date
7/12/2019
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