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BROWN UNIVERSITY HEALTH PHARMACY NO 005
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
BROWN UNIVERSITY HEALTH PHARMACY NO 005
Pharmacy Address
11 FRIENDSHIP ST
SHEFFIELD BLDG 1ST FL
NEWPORT, RI 02840
Pharmacy Comments
Contract Details
Approval Date
4/7/2021
Contract Begin Date
4/12/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Wakefield, Senior VP and CFO
(401) 444-7093
Contract Pharmacy Representative
Brown University Health
CHRISTINE COLLINS, SVP, Pharmacy & Periop, Chief Pharmacy Officer
(401) 444-4434
Signed By Date
4/7/2021
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