Contract Pharmacy Details

RHODE ISLAND CVS PHARMACY, L.L.C.
CH010580 PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Covered Entity Details

Entity Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Subdivision Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC.

Type

HRSA-Funded Health Center

340B ID

CH010580

Entity Address

375 Allens Ave
Providence, RI 02905-5010

Grant Number

H80CS00057

Participating Start Date

7/1/1996

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

4/8/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/8/2020

340B Drug Pricing Program Database