| Name: | Pawtuxet Valley Prescription & Surgical Center, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Revoked Entity |
| Date of Organization in Rhode Island: | 28 Apr 1980 (45 years ago) |
| Date of Dissolution: | 09 Nov 2010 (14 years ago) |
| Date of Status Change: | 09 Nov 2010 (14 years ago) |
| Identification Number: | 000016015 |
| ZIP code: | 02816 |
| County: | Kent County |
| Principal Address: | 85 SANDY BOTTON ROAD, COVENTRY, RI, 02816, USA |
| Purpose: | PHARMACY SALES & SERVICES |
| Fictitious names: |
"ApotheCARE" Division of Pawtuxet Valley (trading name, 1983-09-08 - ) |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437282803 | 2007-03-14 | 2023-03-07 | 65 SANDY BOTTOM RD, COVENTRY, RI, 028165863, US | 65 SANDY BOTTOM RD, COVENTRY, RI, 028165863, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 401-823-9400 |
| Fax | 4108220262 |
Authorized person
| Name | MARK GILMORE |
| Role | DIRECTOR OF OPERATIONS |
| Phone | 4018210600 |
Taxonomy
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PHA00001 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NCPDP |
| Number | 4103406 |
| State | RI |
| Issuer | LICENSE # |
| Number | PHA00001 |
| State | RI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAWTUXET VALLEY PRESICRIPTION 401(K) & PROFIT SHARING PLAN | 2009 | 050433715 | 2010-09-21 | PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER, INC. | 76 | |||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 050433715 |
| Plan administrator’s name | PAWTUXET VALLEY PRESCRIPTION & SURGICAL CENTER, INC. |
| Plan administrator’s address | 85 SANDY BOTTOM RD, COVENTRY, RI, 02816 |
| Administrator’s telephone number | 4018210600 |
Signature of
| Role | Plan administrator |
| Date | 2010-09-21 |
| Name of individual signing | FRANK HARRISON |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BRUCE A. WOLPERT, ESQ. | Agent | 10 DORRANCE STREET SUITE 530, PROVIDENCE, RI, 02903, USA |
| Name | Role | Address |
|---|---|---|
| LEO R BLAIS | PRESIDENT | 85 SANDY BOTTOM ROAD COVENTRY, RI 02816 USA |
| Number | Name | File Date |
|---|---|---|
| 201071988460 | Revocation Certificate For Failure to File the Annual Report for the Year | 2010-11-09 |
| 201063041120 | Revocation Notice For Failure to File An Annual Report | 2010-06-16 |
| 200942970340 | Annual Report | 2009-02-23 |
| 200834058680 | Annual Report | 2008-08-20 |
| 200812779970 | Revocation Notice For Failure to File An Annual Report | 2008-08-04 |
Date of last update: 06 Oct 2024
Sources: Rhode Island Department of State
