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ACCREDO HEALTH GROUP, INC.
DSH410007 RHODE ISLAND HOSPITAL
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Covered Entity Details
Entity Name
RHODE ISLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH410007
Entity Address
593 EDDY STREET
PROVIDENCE, RI 02903
Medicare Provider Number
410007
Participating Start Date
4/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2825 W PERIMETER RD STE 112
INDIANAPOLIS, IN 46241
Pharmacy Comments
Contract Details
Approval Date
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/31/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Mary Wakefield, Senior VP and CFO
(401) 444-7093
Contract Pharmacy Representative
Accredo Specialty Pharmacy / Express Scripts
Gene Maccabe, Senior Director,340B Sales
(615) 943-7500
Signed By Date
4/10/2020
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