Contract Pharmacy Details

MAXI DRUG SOUTH, LP
CH011820 THUNDERMIST HEALTH CENTER

Covered Entity Details

Entity Name

THUNDERMIST HEALTH CENTER

Subdivision Name

THUNDERMIST DENTAL ADMIN WOONSOCKET

Type

HRSA-Funded Health Center

340B ID

CH011820

Entity Address

25 John A. Cummings Way
Woonsocket, RI 02895-3240

Grant Number

H80CS00454

Participating Start Date

10/1/2002

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

MAXI DRUG SOUTH, LP

Pharmacy Address

RITE AID #10244
1155 MAIN ST.
WEST WARWICK, RI 02893

Pharmacy Comments

Contract Details

Approval Date

1/14/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/2/2018
Ownership change

Contacts

Covered Entity Signing Official

Charles T. Jones, President/CEO
(401) 767-4100 Ext: 3176

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

1/14/2014

340B Drug Pricing Program Database