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WALGREEN EASTERN CO., INC.
CH01058W Providence Community Health Centers, Inc., The
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Covered Entity Details
Entity Name
Providence Community Health Centers, Inc., The
Subdivision Name
Randall Sq Specialty Clinic Suite 308
Type
HRSA-Funded Health Center
340B ID
CH01058W
Entity Address
1 Randall Square STE 308
Providence, RI 02904-2774
Grant Number
H80CS00057
Participating Start Date
7/1/2021
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #10256
1140 N. MAIN ST.
PROVIDENCE, RI 02904-1819
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2023
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