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RHODE ISLAND CVS PHARMACY, L.L.C.
CH011990 BLACKSTONE VALLEY COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
BLACKSTONE VALLEY COMMUNITY HEALTH CARE
Subdivision Name
Blackstone Valley Community Health Care
Type
HRSA-Funded Health Center
340B ID
CH011990
Entity Address
39 EAST AVENUE
PAWTUCKET, RI 02860
Grant Number
H80CS00154
Participating Start Date
10/1/2003
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RHODE ISLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00351
1919 MINERAL SPRING AVENUE
NORTH PROVIDENCE, RI 02904
Pharmacy Comments
06/18/2012 city correction (was Providence); 04/06/2012 updated address (was 1919 Mineral Spring North)
Contract Details
Approval Date
10/7/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Raymond Joseph Lavoie, EXECUTIVE DIRECTOR
(401) 729-5235
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2019
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