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RHODE ISLAND CVS PHARMACY, L.L.C.
STD02910 CODAC Behavioral Healthcare, Inc
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Covered Entity Details
Entity Name
CODAC Behavioral Healthcare, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD02910
Entity Address
1052 Park Ave
Cranston, RI 02910
Grant Number
6 NH25PS005160-02-02
Participating Start Date
10/1/2020
Last Recertification Date
5/5/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
RHODE ISLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01544
151 FRANKLIN ST.
WESTERLY, RI 02891
Pharmacy Comments
Contract Details
Approval Date
10/1/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
Linda Hurley, CEO
(401) 275-5037
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/1/2020
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