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WALGREEN EASTERN CO., INC.
CH01058A PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE
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Covered Entity Details
Entity Name
PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE
Subdivision Name
Providence Community Health Center at Prairie Avenue
Type
HRSA-Funded Health Center
340B ID
CH01058A
Entity Address
355 Prairie Ave
Providence, RI 02905-1928
Grant Number
H80CS00057
Participating Start Date
7/1/1996
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 04145
533 ELMWOOD AVE.
PROVIDENCE, RI 02907
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
12/4/2006
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
11/16/2006
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