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RHODE ISLAND CVS PHARMACY, L.L.C.
DSH410009 KENT COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
KENT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH410009
Entity Address
455 TOLL GATE ROAD
WARWICK, RI 02886
Medicare Provider Number
410009
Participating Start Date
7/1/2015
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
RHODE ISLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00212
681 RESERVOIR AVENUE
CRANSTON, RI 02910
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Burke, VP Finance
(401) 737-7010 Ext: 31154
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2020
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