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RHODE ISLAND CVS PHARMACY, L.L.C.
STD02914 CODAC Behavioral Healthcare Inc
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Covered Entity Details
Entity Name
CODAC Behavioral Healthcare Inc
Subdivision Name
CODAC East Bay
Type
Sexually Transmitted Diseases
340B ID
STD02914
Entity Address
850 Waterman Ave
East Providence, RI 02914
Grant Number
6 NH25PS0005160-02
Participating Start Date
7/1/2021
Last Recertification Date
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
RHODE ISLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00994
131 WEBSTER AVENUE
PROVIDENCE, RI 02909
Pharmacy Comments
Contract Details
Approval Date
4/26/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Business decision by covered entity and/or pharmacy
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
4/7/2021
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