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THE STOP & SHOP SUPERMARKET CO
RWII02657 Provincetown AIDS Support Group d.b.a. AIDS Support Group of Cape Cod
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Covered Entity Details
Entity Name
Provincetown AIDS Support Group d.b.a. AIDS Support Group of Cape Cod
Subdivision Name
Type
Ryan White Part B
340B ID
RWII02657
Entity Address
96-98 Bradford Street
Provincetown, MA 02657
Grant Number
X07HA00082
Participating Start Date
4/1/2015
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
THE STOP & SHOP SUPERMARKET CO
Pharmacy Address
STOP & SHOP PHARMACY #2403
56 SHANK PAINTER ROAD
PROVINCETOWN, MA 02657
Pharmacy Comments
Contract Details
Approval Date
4/21/2023
Contract Begin Date
6/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paul E Goddu, CFO
(508) 487-9445
Contract Pharmacy Representative
Stop and Shop
David Dunn, Pharmacy Operations Manager
(774) 644-1263
Signed By Date
4/21/2023
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