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CVS PHARMACY, INC.
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
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY #11131
132 BRADFORD ST
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
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/21/2023
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