Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
CH010580 PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Covered Entity Details

Entity Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC., THE

Subdivision Name

PROVIDENCE COMMUNITY HEALTH CENTERS, INC.

Type

HRSA-Funded Health Center

340B ID

CH010580

Entity Address

375 Allens Ave
Providence, RI 02905-5010

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

WALGREENS #19844
500 BROAD ST STE 6
PROVIDENCE, RI 02907-1367

Pharmacy Comments

Contract Details

Approval Date

1/24/2018

Contract Begin Date

1/25/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/27/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

MERRILL THOMAS, CEO
(401) 444-0400 Ext: 3130

Contract Pharmacy Representative

Providence Community Health Centers
Garrett Clark, CO
(401) 444-0400

Signed By Date

1/24/2018

340B Drug Pricing Program Database