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BROWN UNIVERSITY HEALTH SPECIALTY PHARMA
HV00018 The Miriam Hospital
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Covered Entity Details
Entity Name
The Miriam Hospital
Subdivision Name
Ryan White Care Program
Type
Ryan White Part C
340B ID
HV00018
Entity Address
180 Corliss St.
Suite E
Providence, RI 02904
Grant Number
H76HA00018
Participating Start Date
7/1/2014
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
BROWN UNIVERSITY HEALTH SPECIALTY PHARMA
Pharmacy Address
117 CHAPMAN ST STE 200
PROVIDENCE, RI 02905
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
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
7/15/2019
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