Contract Pharmacy Details

ESI MAIL PHARMACY SERVICE
CH010580 PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

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

ESI MAIL PHARMACY SERVICE

Pharmacy Address

DBA EXPRESS SCRIPTS
7909 S HARDY DR STE 106
TEMPE, AZ 85284-1112

Pharmacy Comments

Contract Details

Approval Date

4/12/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130

Contract Pharmacy Representative

Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

4/12/2023

340B Drug Pricing Program Database