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RHODE ISLAND CVS PHARMACY, L.L.C.
CH010580 PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE
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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 # 00670
601 SMITHFIELD AVENUE
PAWTUCKET, RI 02860
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
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
10/14/2020
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