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RHODE ISLAND CVS PHARMACY, L.L.C.
CH01182C THUNDERMIST HEALTH CENTER
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Covered Entity Details
Entity Name
THUNDERMIST HEALTH CENTER
Subdivision Name
THUNDERMIST WOONSOCKET
Type
HRSA-Funded Health Center
340B ID
CH01182C
Entity Address
450 Clinton St
Woonsocket, RI 02895-3207
Grant Number
H80CS00454
Participating Start Date
7/1/2007
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
RHODE ISLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00590
1054 CASS AVENUE
WOONSOCKET, RI 02895
Pharmacy Comments
03/19/2012 changed address (was 166 CASS AVENUE)
Contract Details
Approval Date
10/20/2011
Contract Begin Date
2/17/2009
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERNEST BALASCO, COO
(401) 767-4100
Contract Pharmacy Representative
VAUGHN KINOSIAN, REGIONAL MANAGER
(401) 952-8627
Signed By Date
8/21/2008
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