Contract Pharmacy Details

BROWN UNIVERSITY HEALTH PHARMACY NO 001
HM10089 RHODE ISLAND HEMOSTASIS AND THROMBOSIS CENTER

Covered Entity Details

Entity Name

RHODE ISLAND HEMOSTASIS AND THROMBOSIS CENTER

Subdivision Name

DIVISION OF PEDIATRICS

Type

Comprehensive Hemophilia Treatment Center

340B ID

HM10089

Entity Address

POTTER BUILDING ROOM 159
593 EDDY STREET
PROVIDENCE, RI 02903

Grant Number

H30MC24048

Participating Start Date

1/1/1996

Last Recertification Date

3/1/2018

Entity Termination Date

10/1/2018

Pharmacy Details

Pharmacy Name

BROWN UNIVERSITY HEALTH PHARMACY NO 001

Pharmacy Address

DAVOL BUILDING
593 EDDY STREET
PROVIDENCE, RI 02903

Pharmacy Comments

Contract Details

Approval Date

1/2/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

GEOFFREY ALLEN, MEDICAL DIRECTOR
(401) 444-7731

Contract Pharmacy Representative

Brown University Health
CHRISTINE COLLINS, SVP, Pharmacy & Periop, Chief Pharmacy Officer
(401) 444-4434

Signed By Date

1/2/2014

340B Drug Pricing Program Database