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CVS PHARMACY, INC.
CH010480 NORTHWEST COMMUNITY HEALTH CARE
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Covered Entity Details
Entity Name
NORTHWEST COMMUNITY HEALTH CARE
Subdivision Name
DBA WellOne Primary Medical and Dental Care
Type
HRSA-Funded Health Center
340B ID
CH010480
Entity Address
36 BRIDGE WAY
PASCOAG, RI 02859
Grant Number
H80CS00308
Participating Start Date
10/1/2003
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 01225
22 MAIN STREET
BLACKSTONE, MA 01504
Pharmacy Comments
Contract Details
Approval Date
1/2/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter Bancroft, President & CEO
(401) 285-5119
Contract Pharmacy Representative
CVS
Kathryn Ficca, Account Manager
(401) 772-7339
Signed By Date
1/2/2020
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