Covered Entity Details

RRC070011-32 CHARLOTTE HUNGERFORD HOSPITAL (Terminated) - information as of 6/15/2025 6:09:11 AM

Main Details

Name

CHARLOTTE HUNGERFORD HOSPITAL

Subdivision Name

CH EMERGENCY WINSTED80 - EMERGENCY

Type

Rural Referral Center

Rural

Yes

340B ID

RRC070011-32

Medicare Provider Number

070011

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/15/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/15/2024

Last Recertification Date

9/3/2024

Termination Date
Termination Reason

4/1/2025
Change of covered entity type

Contacts

Authorizing Official

Hartford HealthCare
Cheryl Considine, Director Finance, NW Region
(860) 496-6740

Primary Contact

Hartford Healthcare
Elyse A Sweeney, System 340B Program Manager
(860) 972-5030

Addresses

Street Address

80 South Main Street
Winsted, CT 06098

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
CT	4041711,4025011	1629075734,1639255870

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC070011-01	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CHRN WSTED80 - REHAB	80 South Main Street	Winsted	CT	Terminated
RRC070011-02	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH EPILEPSY TORR1914 - EPILEPSY	1914 East Main Street	Torrington	CT	Terminated
RRC070011-03	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH PHYS MED REHAB THOM - REHAB	76 Watertown Road	Thomaston	CT	Terminated
RRC070011-04	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CARDIOLOGY THOM - CARDIOLOGY	76 Watertown Road	Thomaston	CT	Terminated
RRC070011-05	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CHRN TOR5 - REHAB	538 Litchfield Street	Torrington	CT	Terminated
RRC070011-06	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH WOUND HYPERBAR TOR - WOUND CARE	7 Felicity Lane	Torrington	CT	Terminated
RRC070011-07	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH NUTRITION THOM - Nutrition	76 Watertown Road	Thomaston	CT	Terminated
RRC070011-08	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH GEN SURG THOM - SURGERY	76 Watertown Road	Thomaston	CT	Terminated
RRC070011-09	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH PULMONARY REHB TOR - PULMONARY REHAB	780 Litchfield Street	Torrington	CT	Terminated
RRC070011-10	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CARDIAC REHAB TOR - CARDIAC REHAB	780 Litchfield Street	Torrington	CT	Terminated
RRC070011-11	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH DIABETES EDU TOR - DIABETES	780 Litchfield Street	TORRINGTON	CT	Terminated
RRC070011-12	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH ADOL IOP TOR50 - BEHAVIORAL HEALTH	50 Litchfield Street	Torrington	CT	Terminated
RRC070011-13	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CHARLOTTES PL - BEHAVIORAL HEALTH	50 Litchfield Street	Torrington	CT	Terminated
RRC070011-14	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH ENT SHARON - ENT	50 Amenia Road	Sharon	CT	Terminated
RRC070011-15	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH NEUROLOGY THOM - NEUROLOGY	76 Watertown Road	Thomaston	CT	Terminated
RRC070011-16	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH NEUROLOGY TORR - NEUROLOGY	780 Litchfield Street	Torrington	CT	Terminated
RRC070011-17	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH BRIDGES EDT OP - BEHAVIORAL HEALTH	50 Litchfield Street	Torrington	CT	Terminated
RRC070011-18	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH RADONC - RADIOLOGY ONCOLOGY	200 Kennedy Road	Torrington	CT	Terminated
RRC070011-19	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH BEHHTH OP WSTD200 - BEHAVIORAL HEALTH	200 New Hartford Road	Winsted	CT	Terminated
RRC070011-20	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH SLEEP CENTER TORR - SLEEP CENTER	1151 East Main Street	Torrington	CT	Terminated
RRC070011-21	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH ENDOCRINOLOGY TOR - ENDOCRINE	780 Litchfield Street	TORRINGTON	CT	Terminated
RRC070011-22	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH PODIATRY THOM - PODIATRY	76 Watertown Road	Thomaston	CT	Terminated
RRC070011-23	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH MOVEMENT DS TOR - MOVEMENT DISORDER	780 Litchfield Street	Torrington	CT	Terminated
RRC070011-24	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CTR YTH FAM OP - BEHAVIORAL HEALTH	50 Litchfield Street	Torrington	CT	Terminated
RRC070011-25	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH NUTRITION WSTD - NUTRITION	80 South Main Street	Winsted	CT	Terminated
RRC070011-26	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CHRN TOR1012 - REHAB	1012 East Main Street	Torrington	CT	Terminated
RRC070011-27	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH NEURO TORR1914 - NEUROLOGY	1914 East Main Street	Torrington	CT	Terminated
RRC070011-28	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH BEHHTH CTR OP WSTED - BEHAVIORAL HEALTH	294 Main Street	Winsted	CT	Terminated
RRC070011-29	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH PHYS MED & REHAB TR - REHAB	538 Litchfield Street	Torrington	CT	Terminated
RRC070011-30	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CARD REHAB WSTED80 - CARDIAC REHAB	80 South Main Street	Winsted	CT	Terminated
RRC070011-31	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CARDIOLOGY TR - CARDIOLOGY	1215 New Litchfield Street	Torrington	CT	Terminated
RRC070011-32	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH EMERGENCY WINSTED80 - EMERGENCY	80 South Main Street	Winsted	CT	Terminated
RRC070011-33	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH UROLOGY TOR - UROLOGY	538 Litchfield Street	Torrington	CT	Terminated
RRC070011-34	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH UROLOGY THOM - UROLOGY	76 Watertown Road	Thomaston	CT	Terminated
RRC070011-35	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH CONNECTIONS OP - BEHAVIORAL HEALTH	50 Litchfield Street	Torrington	CT	Terminated
RRC070011-36	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH ENT CANAAN - ENT	76 Church Street	Canaan	CT	Terminated
RRC070011-37	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH GEN SURG TOR - SURGERY	538 Litchfield Street	Torrington	CT	Terminated
RRC070011-38	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH NEUROSRG TORR1914 - NEURO SURGERY	1914 East Main Street	Torrington	CT	Terminated
RRC070011-39	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH ENT AVON - ENT	339 West Main Street	Avon	CT	Terminated
RRC070011-40	Child	RRC	CHARLOTTE HUNGERFORD HOSPITAL	CH INFECTIOUS DIS TOR - INFECTIOUS DISEASE	538 Litchfield Street	Torrington	CT	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/15/2025 10:52 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	1/15/2025 10:52 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/15/2025 10:52 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2025 12:00:00 AM	1/15/2025 10:52 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	1/15/2025 10:52 AM
Contacts	Authorizing Official	Update	Change Request	Curtin, Sean Michael Vice President, Finance, Hartford Region Hartford Healthcare 8605450585	Considine, Cheryl Director Finance, NW Region Hartford HealthCare 8604966740	12/30/2024 10:08 AM
Contacts	Authorizing Official	Update	Profile Change Request	Curtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 8602245194	Curtin, Sean Michael Vice President, Finance, Hartford Region Hartford Healthcare 8605450585	12/26/2024 7:46 AM
Contacts	Signed By	Update	Profile Change Request	Curtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 8602245194	Curtin, Sean Michael Vice President, Finance, Hartford Region Hartford Healthcare 8605450585	12/26/2024 7:46 AM
Details	Last Recertification Date	Update	Recertification		9/3/2024 11:22:24 AM	9/3/2024 11:22 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Curtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 8602245194	2/15/2024 11:51 AM
Details	340B ID	Update	New Registration		RRC070011-32	2/15/2024 11:51 AM
Details	Entity Subname	Update	New Registration	CH EMERGENCY WINSTED80	CH EMERGENCY WINSTED80 - EMERGENCY	2/15/2024 11:51 AM
Dates	Participating Approval Date	Update	New Registration		2/15/2024 11:51:24 AM	2/15/2024 11:51 AM
Details	State	Update	New Registration	Pending	Approved	2/15/2024 11:51 AM
Dates	Signed By Date	Update	New Registration		1/15/2024 5:17:35 PM	2/15/2024 11:51 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/15/2024 11:51 AM
Addresses	Main Address	Insert	New Registration		80 South Main Street Winsted, CT 06098	1/15/2024 3:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/15/2024 3:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		4041711	1/15/2024 3:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	1/15/2024 3:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/15/2024 3:16 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		4025011	1/15/2024 3:16 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	1/15/2024 3:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629075734	1/15/2024 3:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		CT	1/15/2024 3:16 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1639255870	1/15/2024 3:16 PM
Medicaid Billing	NPI: State	Insert	New Registration		CT	1/15/2024 3:16 PM
Contacts	Primary Contact	Insert	New Registration		Sweeney, Elyse A System 340B Program Manager Hartford Healthcare 8609725030	1/15/2024 3:16 PM
Contacts	Authorizing Official	Insert	New Registration		Curtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 8602245194	1/15/2024 3:16 PM
Details	Assistance Received From Date	Insert	New Registration			1/15/2024 3:16 PM
Details	Assistance Received To Date	Insert	New Registration			1/15/2024 3:16 PM
Details	Last Recertification Date	Insert	New Registration			1/15/2024 3:16 PM
Details	Grant Number	Insert	New Registration			1/15/2024 3:16 PM
Details	340B ID	Insert	New Registration			1/15/2024 3:16 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/15/2024 3:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/15/2024 3:16 PM
Details	Medicare Provider Number	Insert	New Registration		070011	1/15/2024 3:16 PM
Details	Entity Name	Insert	New Registration		CHARLOTTE HUNGERFORD HOSPITAL	1/15/2024 3:16 PM
Details	NOFO Number	Insert	New Registration			1/15/2024 3:16 PM
Details	Program Code	Insert	New Registration		RRC	1/15/2024 3:16 PM
Details	Entity Subname	Insert	New Registration		CH EMERGENCY WINSTED80	1/15/2024 3:16 PM
Dates	Participating Approval Date	Insert	New Registration			1/15/2024 3:16 PM
Details	State	Insert	New Registration		Pending	1/15/2024 3:16 PM
Dates	Registration Date	Insert	New Registration		1/15/2024 3:16:10 PM	1/15/2024 3:16 PM
Dates	Signed By Date	Insert	New Registration			1/15/2024 3:16 PM
Dates	Start Date	Insert	New Registration			1/15/2024 3:16 PM
Terminations	Termination Comments	Insert	New Registration			1/15/2024 3:16 PM
Terminations	Termination Date	Insert	New Registration			1/15/2024 3:16 PM
Terminations	Termination Effective Date	Insert	New Registration			1/15/2024 3:16 PM
Terminations	Termination Reason	Insert	New Registration			1/15/2024 3:16 PM