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RHODE ISLAND CVS PHARMACY, L.L.C.
STD02860 CODAC Behavioral Healthcare Inc
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Covered Entity Details
Entity Name
CODAC Behavioral Healthcare Inc
Subdivision Name
CODAC Pawtucket
Type
Sexually Transmitted Diseases
340B ID
STD02860
Entity Address
600 Pawtucket Ave
Pawtucket, RI 02860
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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