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BROWN UNIVERSITY HEALTH PHARMACY NO 001
DSH410006 NEWPORT HOSPITAL
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Covered Entity Details
Entity Name
NEWPORT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH410006
Entity Address
11 FRIENDSHIP STREET
NEWPORT, RI 02840
Medicare Provider Number
410006
Participating Start Date
1/1/2020
Last Recertification Date
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
BROWN UNIVERSITY HEALTH PHARMACY NO 001
Pharmacy Address
DAVOL BUILDING
593 EDDY STREET
PROVIDENCE, RI 02903
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
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
1/15/2020
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