Contract Pharmacy Details

RHODE ISLAND CVS PHARMACY, L.L.C.
HV00018 The Miriam Hospital

Covered Entity Details

Entity Name

The Miriam Hospital

Subdivision Name

Ryan White Care Program

Type

Ryan White Part C

340B ID

HV00018

Entity Address

180 Corliss St.
Suite E
Providence, RI 02904

Grant Number

H76HA00018

Participating Start Date

7/1/2014

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

RHODE ISLAND CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04096
309 BROAD ST.
CENTRAL FALLS, RI 02863

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mary Wakefield, Senior VP and CFO
(401) 444-7093

Contract Pharmacy Representative

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

Signed By Date

7/15/2020

340B Drug Pricing Program Database