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RHODE ISLAND CVS PHARMACY, L.L.C.
STD02904 The Miriam Hospital
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Covered Entity Details
Entity Name
The Miriam Hospital
Subdivision Name
Immunology Center
Type
Sexually Transmitted Diseases
340B ID
STD02904
Entity Address
180 Corliss St.
Suite F
Providence, RI 02904
Grant Number
NH25PS0051600501
Participating Start Date
1/1/2015
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
RHODE ISLAND CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00856
400 ADMIRAL STREET
PROVIDENCE, RI 02908
Pharmacy Comments
Contract Details
Approval Date
1/9/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael D Dawson, VP Finance
(401) 444-2648
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/9/2025
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