Covered Entity Details

DSH070035 The Hospital of Central Connecticut (Active) - information as of 6/15/2025 6:07:04 AM

Main Details

Name

The Hospital of Central Connecticut

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH070035

Medicare Provider Number

070035

Additional Details

Current Program Status

Active

Registration Date

4/10/2013

Participating Start Date

7/1/2013

Participating Approval Date

5/13/2013

Last Recertification Date

8/27/2024

Contacts

Authorizing Official

Hartford Healthcare
Joseph Del Mastro, HHC Reg VP Finance Central
(959) 236-3295

Primary Contact

The Hospital of Central Connecticut
Allison Gandini, 340B Program Coordinator
(860) 224-5900 Ext: 6228

Addresses

Street Address

100 Grand St.
New Britain, CT 06052

Billing Address

The Hospital of Central Connecticut
PO BOX 5037
ATTN: Accounts Payable
Hartford, CT 06102-5037

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	004025243,004041950	1053477075,1548225360,1992867006,1508928615

Shipping Addresses

Shipping Address 1

The Hospital of Central Connecticut
100 Grand Street
New Britain, CT 06052

Shipping Address 2

Safecor Health
317 New Boston Street, Suite 100
Woburn, MA 01801

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/15/2019	07/01/2019		07/01/2019
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/15/2019	07/01/2019	12/16/2020	12/30/2020
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/15/2019	07/01/2019	12/16/2020	12/30/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/15/2019	07/01/2019		07/01/2019
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/15/2019	07/01/2019	12/16/2020	12/30/2020
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/15/2019	07/01/2019	12/16/2020	12/30/2020
Contract Detail	AETNA SPECIALTY PHARMACY, LLC	503 SUNPORT LN		ORLANDO	FL	32809-7874	04/15/2019	07/01/2019	02/18/2021	03/02/2022
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	10/16/2023	01/01/2024		01/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	10/16/2023	01/01/2024		01/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	10/16/2023	01/01/2024		01/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	07/17/2024	10/01/2024		10/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	10/16/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/19/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	10/19/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/16/2018	01/01/2019		01/01/2019
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00294	177 COLUMBUS BLVD.	NEW BRITAIN	CT	06051	04/18/2014	07/01/2014	01/01/2016	04/25/2017
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00760	713 WEST MAIN STREET	NEW BRITAIN	CT	06053	04/18/2014	07/01/2014	01/01/2016	04/25/2017
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00839	14 FARMINGTON AVENUE	PLAINVILLE	CT	06062	04/18/2014	07/01/2014	01/01/2016	04/25/2017
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01060	326 MAIN STREET	SOUTHINGTON	CT	06489	04/18/2014	07/01/2014	01/01/2016	04/25/2017
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02119	1055 FARMINGTON AVENUE	KENSINGTON	CT	06037	04/18/2014	07/01/2014	01/01/2016	04/25/2017
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01060	326 MAIN STREET	SOUTHINGTON	CT	06489	10/19/2018	01/01/2019		01/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00760	713 WEST MAIN STREET	NEW BRITAIN	CT	06053	10/19/2018	01/01/2019		01/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02119	1055 FARMINGTON AVENUE	KENSINGTON	CT	06037	10/19/2018	01/01/2019		01/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00294	177 COLUMBUS BLVD.	NEW BRITAIN	CT	06051	10/19/2018	01/01/2019		01/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00839	14 FARMINGTON AVENUE	PLAINVILLE	CT	06062	10/19/2018	01/01/2019		01/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00145	330 MAIN STREET	FARMINGTON	CT	06032	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02140	526 MERIDEN ROAD	WATERBURY	CT	06705	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01960	1279 WEST MAIN STREET	WATERBURY	CT	06708	04/15/2019	07/01/2019	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02388	2000 NORTH MAIN STREET	WATERBURY	CT	06704	04/15/2019	07/01/2019	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00953	45 SOUTH MAIN ST. FARMINGTON PLAZA	UNIONVILLE	CT	06085	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01156	1240 FARMINGTON AVENUE	WEST HARTFORD	CT	06107	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01180	358 W. MAIN ST,	AVON	CT	06001	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00288	839 FARMINGTON AVE	BRISTOL	CT	06010	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00364	308 MAIN STREET EXTENSION	MIDDLETOWN	CT	06457	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00348	1078 SILAS DEANE HIGHWAY	WETHERSFIELD	CT	06109	04/15/2019	07/01/2019		07/01/2019
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00691	1181 MAIN STREET	NEWINGTON	CT	06111	01/06/2020	04/01/2020		04/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01028	724 QUEEN ST.	SOUTHINGTON	CT	06489	01/06/2020	04/01/2020		04/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00865	839 EAST MAIN STREET	MERIDEN	CT	06450	01/06/2020	04/01/2020		04/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	CVS/PHARMACY # 5703	60 MIDDLE ST.	BRISTOL	CT	06010	01/06/2020	04/01/2020		04/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01155	308 BERLIN TURNPIKE	BERLIN	CT	06037	01/06/2020	04/01/2020	10/17/2022	09/18/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00775	2045 DIXWELL AVE.	HAMDEN	CT	06514	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 5263	150 WASHINGTON STREET	HARTFORD	CT	06106	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05450	766 NEW LONDON TURNPIKE	GLASTONBURY	CT	06033	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04436	241 MIDDLE TURNPIKE WEST	MANCHESTER	CT	06040	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06807	153 BROAD STREET	MERIDEN	CT	06450	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00954	311 MAIN ST. VILLAGE PLAZA	TERRYVILLE	CT	06786	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00916	26 DAVIS STREET	OAKVILLE	CT	06779	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01244	26 WATERBURY ROAD	PROSPECT	CT	06712	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01098	47 HAZARD AVE	ENFIELD	CT	06082	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00124	98 BRIDGE ST.	NAUGATUCK	CT	06770	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #11072	344 N MAIN ST	WEST HARTFORD	CT	06117	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02682	47 MAIN ST.	WINSTED	CT	06098	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10317	8 ROYCE CIRCLE	STORRS MANSFIELD	CT	06268-2258	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00349	484 WINDSOR AVENUE	WINDSOR	CT	06095	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02018	540 WEST MAIN STREET	MERIDEN	CT	06451	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02502	581 HIGHLAND AVE.	CHESHIRE	CT	06410	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00840	908-910 MAPLE AVENUE	HARTFORD	CT	06114	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02219	2427 MAIN STREET	ROCKY HILL	CT	06067	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02022	163 MOUNTAIN RD	SUFFIELD	CT	06078	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01268	106 BOSTON POST ROAD	WATERFORD	CT	06385	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03835	72 BERLIN RD.	CROMWELL	CT	06416	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01183	777 MAIN STREET	HARTFORD	CT	06103	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2253	111 ALBANY TURNPIKE	CANTON	CT	06019	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00671	1099 NEW BRITAIN AVENUE	WEST HARTFORD	CT	06110	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02525	323 CROMWELL AVENUE	ROCKY HILL	CT	06067	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00459	2639 MAIN STREET	GLASTONBURY	CT	06033	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01166	219 BROAD STREET	WINDSOR	CT	06095	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10130	110 MAIN STREET	HEBRON	CT	06248	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 16633	475 HARTFORD RD	NEW BRITAIN	CT	06053	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01276	81 NORTH STREET	BRISTOL	CT	06010	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00785	632 MIDDLE TURNPIKE	STORRS MANSFIELD	CT	06268	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01242	714 HOPMEADOW ST. DRACUT MALL	SIMSBURY	CT	06070	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 17491	600 EXECUTIVE BLVD	SOUTHINGTON	CT	06489	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01038	1044 BOULEVARD	WEST HARTFORD	CT	06119	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 85	972 SILVER LN.	EAST HARTFORD	CT	06118	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01968	369 MAIN STREET	EAST HAVEN	CT	06512	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07916	292 SPIELMAN HWY.	BURLINGTON	CT	06013	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02153	150 SOUTH MAIN STREET	WEST HARTFORD	CT	06107	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02099	479 BLUE HILLS AVE.	HARTFORD	CT	06112	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01097	661 MAIN STREET	TORRINGTON	CT	06790	04/14/2020	07/01/2020	01/18/2021	01/26/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05848	119 S. MAIN ST.	COLCHESTER	CT	06415	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02896	675 WASHINGTON STREET	MIDDLETOWN	CT	06457	04/14/2020	07/01/2020		07/01/2020
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 16712	474 CHAMBERLAIN HWY	MERIDEN	CT	06451	04/15/2021	07/01/2021		07/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00692	162 WASHINGTON AVENUE	NORTH HAVEN	CT	06473	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01151	464 REIDVILLE DRIVE	WATERBURY	CT	06705	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01123	22 DEPOT HILL RD.	SOUTHBURY	CT	06488	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	CVS PHARMACY # 16925	3265 BERLIN TURNPIKE	NEWINGTON	CT	06111	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 935	891 NORTH COLONY RD.	WALLINGFORD	CT	06492	01/14/2022	04/01/2022		04/01/2022
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01070	90 MAIN STREET	WINDSOR LOCKS	CT	06096	01/14/2022	04/01/2022		04/01/2022
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00333	978 FARMINGTON AVENUE	WEST HARTFORD	CT	06107	01/14/2022	04/01/2022	09/20/2023	09/20/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00185	215 WEST STREET	SEYMOUR	CT	06483	01/14/2022	04/01/2022		04/01/2022
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01148	905 SOUTH MAIN ST.	CHESHIRE	CT	06410	07/09/2022	10/01/2022		10/01/2022
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02153	150 SOUTH MAIN STREET	WEST HARTFORD	CT	06107	10/11/2023	01/01/2024		01/01/2024
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/17/2021	07/01/2021		07/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/17/2021	07/01/2021		07/01/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/15/2021	10/01/2021		10/01/2021
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	04/15/2021	07/01/2021	04/20/2022	05/08/2023
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	10/16/2023	01/01/2024		01/01/2024
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/15/2019	07/01/2019	12/16/2020	12/30/2020
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/15/2019	07/01/2019	12/16/2020	12/30/2020
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/15/2019	07/01/2019		07/01/2019
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/15/2019	07/01/2019	12/16/2020	12/30/2020
Contract Detail	HARTFORD HOSPITAL	DBA HARTFORD HEALTHCARE RETAIL PHARMACY	85 SEYMOUR ST STE 105	HARTFORD	CT	06106	11/19/2015	01/01/2016		04/25/2017
Contract Detail	MIDSTATE MEDICAL CENTER	435 LEWIS AVE	PHARMACY	MERIDEN	CT	06451-2101	01/18/2024	04/01/2024		04/01/2024
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	100 TRAP FALLS RD SUITE 200	SHELTON	CT	06484	10/15/2020	01/01/2021		01/01/2021
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	10/15/2020	01/01/2021		01/01/2021
Contract Detail	OPTION CARE ENTERPRISES, INC.	OPTION CARE	870 N. ARLINGTON HEIGHTS RD SUITE 101	ITASCA	IL	60143	10/15/2020	01/01/2021		01/01/2021
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/19/2022	04/20/2022		04/21/2022
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/17/2025	04/01/2025		04/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/17/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/17/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/06/2021	10/01/2021		10/01/2021
Contract Detail	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	07/06/2021	10/01/2021	06/30/2022	04/18/2025
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	10/16/2018	01/01/2019		01/01/2019
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 2516	35 KNEELAND STREET	BOSTON	MA	02111	04/15/2021	07/01/2021		07/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	07/15/2021	10/01/2021		10/01/2021
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	10/16/2023	01/01/2024		01/01/2024
Contract Detail	RITE AID OF CONNECTICUT, INC.	RITE AID #4620	744 WOLCOTT ROAD	WOLCOTT	CT	06716	01/17/2023	04/01/2023		04/01/2023
Contract Detail	RITE AID OF CONNECTICUT, INC.	RITE AID #576	605 NORTH COLONY ROAD	WALLINGFORD	CT	06492	01/17/2023	04/01/2023		04/01/2023
Contract Detail	RITE AID OF CONNECTICUT, INC.	RITE AID #1087	180 MAIN STREET	CHESHIRE	CT	06410	01/17/2023	04/01/2023		04/01/2023
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	10/16/2023	01/01/2024		01/01/2024
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	10/16/2023	01/01/2024		01/01/2024
Contract Detail	THE STOP & SHOP SUPERMARKET	DBA: STOP & SHOP PHARMACY #645	1309 CORBIN AVENUE	NEW BRITAIN	CT	06053	10/16/2020	01/01/2021		01/01/2021
Contract Detail	THE STOP & SHOP SUPERMARKET	STOP & SHOP PHARMACY #614	1135 FARMINGTON AVENUE	BERLIN	CT	06037	10/16/2020	01/01/2021		01/01/2021
Contract Detail	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #642	747 PINE STREET	BRISTOL	CT	06010	10/16/2020	01/01/2021	12/23/2023	01/18/2024
Contract Detail	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY#630	44 FENN ROAD	NEWINGTON	CT	06111	10/16/2020	01/01/2021	12/23/2023	01/18/2024
Contract Detail	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY#638	930 NORTH COLONY ROAD	WALLINGFORD	CT	06492	10/16/2020	01/01/2021	12/23/2023	01/18/2024
Contract Detail	THE STOP & SHOP SUPERMARKT CO	DBA STOP & SHOP PHARMACY #684	505 NORTH MAIN ST	SOUTHINGTON	CT	06489	10/16/2020	01/01/2021	12/23/2023	01/18/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15207	668 FARMINGTON AVE	WEST HARTFORD	CT	06119	04/18/2014	07/01/2014	01/05/2016	04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03827	161 WASHINGTON ST	HARTFORD	CT	06106	04/18/2014	07/01/2014	03/18/2025	03/18/2025
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05134	540 BUSHY HILL ROAD	SIMSBURY	CT	06070	04/18/2014	07/01/2014		04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07047	2920 BERLIN TURNPIKE	NEWINGTON	CT	06111-4116	04/18/2014	07/01/2014		04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07086	5 FARMINGTON AVE	PLAINVILLE	CT	06062-1726	04/18/2014	07/01/2014		04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07641	359 MAIN ST	SOUTHINGTON	CT	06489-4538	04/18/2014	07/01/2014		04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #10119	980 FARMINGTON AVE	BERLIN	CT	06037	04/18/2014	07/01/2014		04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10203	25 MAIN ST	BRISTOL	CT	06010-6528	04/18/2014	07/01/2014	11/08/2023	11/10/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 11825	525 FARMINGTON AVENUE	BRISTOL	CT	06010	04/18/2014	07/01/2014		04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #15389	5 MILL STREET	UNIONVILLE	CT	06085-1019	04/18/2014	07/01/2014	01/05/2016	04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07585	102 WASHINGTON STREET	NEW BRITAIN	CT	06051-1826	04/18/2014	07/01/2014		04/25/2017
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19842	40 CEDAR ST	NEWINGTON	CT	06111	10/15/2018	01/01/2019	11/07/2022	05/08/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18243	1350 STANLEY ST	NEW BRITAIN	CT	06053	10/15/2018	01/01/2019	05/19/2025	05/22/2025
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #11604	220 ALBANY TURNPIKE CANTON VILLAGE ROUTE #44	CANTON	CT	06019	04/15/2019	07/01/2019	02/19/2024	03/13/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 10003	134 STATE ST STE 110	MERIDEN	CT	06450	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #21180	60 BANK ST STE 100	WATERBURY	CT	06702	04/15/2019	07/01/2019		07/01/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07935	54 BOSTON POST RD	ORANGE	CT	06477-3201	07/06/2021	10/01/2021	05/10/2023	06/27/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #9818	4 HAMMERHEAD PL	CROMWELL	CT	06416	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16548	300 FAIRFIELD AVE STE 103	BRIDGEPORT	CT	06604	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09071	49 WASHINGTON AVE	NORTH HAVEN	CT	06473-1704	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17899	455 S MAIN ST.	THOMASTON	CT	06787	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05948	425 W MAIN ST	MERIDEN	CT	06451	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09784	20 CONNECTICUT BLVD	EAST HARTFORD	CT	06108-3007	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #13969	55 PARK ST STE 1A	NEW HAVEN	CT	06511	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07750	940 S QUAKER LN	WEST HARTFORD	CT	06110	07/06/2021	10/01/2021	11/13/2023	11/13/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #09820	825 E MAIN ST	MERIDEN	CT	06450-6064	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19604	8 S MAIN ST. STE A	TERRYVILLE	CT	06786	07/06/2021	10/01/2021	06/29/2023	06/29/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02858	633 WASHINGTON	MIDDLETOWN	CT	06457	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06966	11 MERIDEN ROAD	WATERBURY	CT	06705-1933	07/06/2021	10/01/2021	04/22/2025	04/22/2025
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10647	284 S COLONY RD	WALLINGFORD	CT	06492	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #12338	311 E MAIN ST	MIDDLETOWN	CT	06457-4556	07/06/2021	10/01/2021	04/23/2025	04/23/2025
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02410	1697 WHITNEY AVE STE 3	HAMDEN	CT	06517	07/06/2021	10/01/2021		10/01/2021
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/18/2014	07/01/2014	08/17/2015	04/25/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH070035A	Child	DSH	The Hospital of Central Connecticut	THE HOSPITAL OF CENTRAL CONNECTICUT / Outpatient Infusion clinic	183 North Mountain Road	NEW BRITAIN	CT	Active
DSH070035AA	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC Respiratory Care	81 Meriden Ave	Southington	CT	Active
DSH070035AB	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC EEG	81 Meriden Ave	Southington	CT	Terminated
DSH070035AC	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC Cardiac Rehab	81 Meriden Ave	Southington	CT	Active
DSH070035AD	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC MRI	81 Meriden Ave	Southington	CT	Active
DSH070035AE	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC Cardiac Non Invasive	81 Meriden Ave	Southington	CT	Active
DSH070035AF	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC XRay	81 Meriden Ave	Southington	CT	Active
DSH070035AG	Child	DSH	The Hospital of Central Connecticut	Cancer Center - HOCC Med Onc CI	183 North Mountain Rd	New Britain	CT	Active
DSH070035AH	Child	DSH	The Hospital of Central Connecticut	HOCC Counseling Center Southington - HOCC Counsel CTR Sth	98 Main Street	Southington	CT	Active
DSH070035AJ	Child	DSH	The Hospital of Central Connecticut	HOCC Wound Care NB - HOCC Wound Care NB	5 Highland Street	New Britian	CT	Active
DSH070035AK	Child	DSH	The Hospital of Central Connecticut	HOCC BMC Med Onc CI	81 Meriden Ave	Southington	CT	Active
DSH070035AL	Child	DSH	The Hospital of Central Connecticut	HOCC IC MRI - Cancer Center MRI	201 North Mountain Road	Plainville	CT	Active
DSH070035AM	Child	DSH	The Hospital of Central Connecticut	HOCC GYNONC 183 - HOCC GYNONC 183	183 North Mountain Road	New Britain	CT	Active
DSH070035AN	Child	DSH	The Hospital of Central Connecticut	The Hospital of Central Connecticut - HOCC PAT	5 Highland Steet	New Britain	CT	Active
DSH070035AP	Child	DSH	The Hospital of Central Connecticut	HOCC MED ONC CI TOR - Clinic- Oncology	540 Litchfield Street	Torrington	CT	Active
DSH070035AQ	Child	DSH	The Hospital of Central Connecticut	HOCC MED ONC CI MRDN - MED ONC	435 Lewis Avenue	Meriden	CT	Active
DSH070035AR	Child	DSH	The Hospital of Central Connecticut	HOCC LIMB PRESERVATION - LIMB PRESERVATION	5 Highland Street	New Britain	CT	Active
DSH070035AS	Child	DSH	The Hospital of Central Connecticut	HOCC INFUSION TOR - Oncology	540 Litchfield Street	Torrington	CT	Active
DSH070035AT	Child	DSH	The Hospital of Central Connecticut	HOCC INFUSION MRDN - MRND INFUSION	435 LEWIS AVENUE	MERIDEN	CT	Active
DSH070035AU	Child	DSH	The Hospital of Central Connecticut	HOCC BMC Infusion CVDM - Infusion	81 Meriden Ave	Southington	CT	ToBeTerminated
DSH070035B	Child	DSH	The Hospital of Central Connecticut	Cancer Center Nuclear Medicine	201 North Mountain Road	Plainville	CT	Active
DSH070035C	Child	DSH	The Hospital of Central Connecticut	CTR for Metabolic Health/Diabetes & Endocrine Services	11 South Road Suit 130	Farmington	CT	Terminated
DSH070035D	Child	DSH	The Hospital of Central Connecticut	Cancer CTR Rad Onc/ Radiation Therapy	183 North Mountain Road	New Britain	CT	Active
DSH070035E	Child	DSH	The Hospital of Central Connecticut	Imaging Center/ Mammography Services	201 North Mountain Road	Plainville	CT	Active
DSH070035F	Child	DSH	The Hospital of Central Connecticut	Imaging Center/Cancer Center Diagnostic	201 North Mountain Road	Plainville	CT	Active
DSH070035G	Child	DSH	The Hospital of Central Connecticut	Imaging Center/ Cancer Center Ultrasound	201 North Mountain Road	Plainville	CT	Active
DSH070035H	Child	DSH	The Hospital of Central Connecticut	Imaging Center/Cancer Center CT Scan	201 North Mountain Road	Plainville	CT	Active
DSH070035J	Child	DSH	The Hospital of Central Connecticut	Bristol Wound Care	22 Pine Street	Bristol	CT	Active
DSH070035K	Child	DSH	The Hospital of Central Connecticut	HISPANIC COUNSELING CENTER	73 CEDAR STREET	NEW BRITAIN	CT	Terminated
DSH070035L	Child	DSH	The Hospital of Central Connecticut	OLDER ADULT SERVICES	73 CEDAR STREET	NEW BRITAIN	CT	ToBeTerminated
DSH070035M	Child	DSH	The Hospital of Central Connecticut	SUBSTANCE ABUSE SERVICES	73 CEDAR STREET	NEW BRITAIN	CT	Terminated
DSH070035N	Child	DSH	The Hospital of Central Connecticut	META HEALTH-SOUTHINGTON	98 MAIN STREET	SOUTHINGTON	CT	Terminated
DSH070035P	Child	DSH	The Hospital of Central Connecticut	Outpatient Cancer Institute - Rehab Services	183 NORTH MOUNTAIN ROAD	NEW BRITAIN	CT	Active
DSH070035Q	Child	DSH	The Hospital of Central Connecticut	Medical Oncology Clinic - Bristol	22 PINE STREET	BRISTOL	CT	Terminated
DSH070035R	Child	DSH	The Hospital of Central Connecticut	HOCC Behavioral Health/IOP NB_OP NB	73 CEDAR ST	NEW BRITAIN	CT	Active
DSH070035S	Child	DSH	The Hospital of Central Connecticut	Bradley Memorial Campus - Outpatient Dept	81 Meriden Avenue	Southington	CT	Active
DSH070035T	Child	DSH	The Hospital of Central Connecticut	COUNSELING CENTER - Victims Services Program/Hispanic	73 Cedar Street	New Britain	CT	Terminated
DSH070035U	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC UltraSound	81 Meriden Ave	Southington	CT	Active
DSH070035V	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC Emergency Dept	81 Meriden Ave	Southington	CT	Active
DSH070035W	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC Pulmonary Lab	81 Meriden Ave	Southington	CT	Active
DSH070035X	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC CatScan	81 Meriden Ave	Southington	CT	Active
DSH070035Y	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC BMC NucMed	81 Meriden Ave	Southington	CT	Active
DSH070035Z	Child	DSH	The Hospital of Central Connecticut	Bradley Campus - HOCC Rehab Services Southington	55 Meriden Ave	Southington	CT	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Recertification		1508928615	8/27/2024 8:06 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	8/27/2024 8:06 PM
Details	Last Recertification Date	Update	Recertification	8/28/2023 9:32:47 AM	8/27/2024 8:06:07 PM	8/27/2024 8:06 PM
Contacts	Authorizing Official	Update	Change Request	Curtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 8602245194	Del Mastro, Joseph HHC Reg VP Finance Central Hartford Healthcare 9592363295	1/12/2024 10:16 AM
Details	Last Recertification Date	Update	Recertification	8/26/2022 3:45:00 PM	8/28/2023 9:32:47 AM	8/28/2023 9:32 AM
Contacts	Primary Contact	Update	Change Request	Sweeney, Elyse A System 340B Program Manager Hartford Healthcare 8609725030	Gandini, Allison 340B Program Coordinator The Hospital of Central Connecticut 8602245900-6228	4/25/2023 8:43 AM
Addresses	Shipping Address	Insert	Change Request		The Hospital of Central Connecticut 100 Grand Street New Britain, CT 06052	12/12/2022 1:22 PM
Addresses	Shipping Address	Insert	Change Request		Safecor Health 317 New Boston Street, Suite 100 Woburn, MA 01801	12/12/2022 1:22 PM
Contacts	Primary Contact	Update	Change Request	Gandini, Allison 340B Program Coordinator The Hospital of Central Connecticut 8602245900-6228	Sweeney, Elyse A System 340B Program Manager Hartford Healthcare 8609725030	11/28/2022 7:31 AM
Details	Last Recertification Date	Update	Recertification	9/7/2021 2:44:08 PM	8/26/2022 3:45:00 PM	8/26/2022 3:45 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 8:52:33 PM	9/7/2021 2:44:08 PM	9/7/2021 2:44 PM
Contacts	Primary Contact	Update	Profile Change Request	Gandini, Allison Financial Programs tech The Hospital of Central Connecticut 8602245900-6228	Gandini, Allison 340B Program Coordinator The Hospital of Central Connecticut 8602245900-6228	4/15/2021 9:05 AM
Contacts	Primary Contact	Update	Change Request	Amenta, Allison Financial Programs Tech The Hospital of Central Connecticut 8602245900-6228	Gandini, Allison Financial Programs tech The Hospital of Central Connecticut 8602245900-6228	12/7/2020 12:19 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 8:52 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		004041950	9/9/2020 8:52 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/9/2020 8:52 PM
Medicaid Billing	NPI: State	Update	Recertification		CT	9/9/2020 8:52 PM
Medicaid Billing	NPI: State	Update	Recertification		CT	9/9/2020 8:52 PM
Medicaid Billing	NPI: State	Update	Recertification		CT	9/9/2020 8:52 PM
Details	Last Recertification Date	Update	Recertification	9/13/2019 7:34:35 AM	9/9/2020 8:52:33 PM	9/9/2020 8:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1992867006	3/29/2020 9:55 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1548225360	1/6/2020 6:59 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1053477075	10/10/2019 1:55 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1548225360 ( )		10/10/2019 1:55 PM
Details	Last Recertification Date	Update	Recertification	9/7/2018 11:28:30 AM	9/13/2019 7:34:35 AM	9/13/2019 7:34 AM
Contacts	Authorizing Official	Update	Change Request	Edwards, Janette Vice President Operations, Central Region Hartford HealthCare 8602245421	Curtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 8602245194	5/8/2019 7:37 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548225360	9/7/2018 11:28 AM
Details	Last Recertification Date	Update	Recertification	11/20/2017 11:53:04 AM	9/7/2018 11:28:30 AM	9/7/2018 11:28 AM
Contacts	Primary Contact	Update	Change Request	Girouard, David Director of Pharmacy Hospital of Central Connecticut 8602245421	Amenta, Allison Financial Programs Tech The Hospital of Central Connecticut 8602245900-6228	4/4/2018 10:52 AM
Details	Last Recertification Date	Update	Recertification	8/26/2016 12:00:00 AM	11/20/2017 11:53:04 AM	11/20/2017 11:53 AM
Contacts	Authorizing Official	Update	AO Change Request	Stevens, Catherine Vice President Patient Care Services 8602245640	Edwards, Janette Vice President Operations, Central Region Hartford HealthCare 8602245421	11/16/2017 1:26 PM
Contacts	Primary Contact	Update		Girouard, David Director of Pharmacy 8602245421	Girouard, David Director of Pharmacy Hospital of Central Connecticut 8602245421	9/29/2017 1:55 PM
Addresses	Main Address	Insert			100 Grand St. New Britain, CT 06052	8/3/2017 7:33 AM
Addresses	Billing Address	Insert			The Hospital of Central Connecticut PO BOX 5037 ATTN: Accounts Payable Hartford, CT 06102-5037	8/3/2017 7:33 AM
Contacts	Signed By	Insert			Hanks, Steven D. Executive VP & Chief Medical Officer 8602245554	8/3/2017 7:33 AM
Contacts	Authorizing Official	Update		Freiheit, Carolyn Central Region VP Finance 8602245272	Stevens, Catherine Vice President Patient Care Services 8602245640	8/3/2017 7:33 AM
Contacts	Primary Contact	Update		Girouard, David Director of Pharmacy 8602245421	Girouard, David Director of Pharmacy 8602245421	8/3/2017 7:33 AM
Contacts	Authorizing Official	Insert			Freiheit, Carolyn Central Region VP Finance 8602245272	6/27/2017 7:34 AM
Details	Last Recertification Date	Update		8/13/2015 12:00:00 AM	8/26/2016 12:00:00 AM	8/26/2016 2:25 PM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/13/2015 12:00:00 AM	8/13/2015 9:09 AM
Contacts	Primary Contact	Insert			Girouard, David Director of Pharmacy 8602245421	8/27/2014 2:37 PM
Details	Last Recertification Date	Update		9/7/2013 4:01:40 PM	8/27/2014 12:00:00 AM	8/27/2014 2:37 PM
Details	Last Recertification Date	Update			9/7/2013 4:01:40 PM	9/7/2013 4:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	6/10/2013 4:40 PM
Medicaid Billing	Medicaid: Number	Insert			004025243	6/10/2013 4:40 PM
Medicaid Billing	Medicaid: State	Insert			CT	6/10/2013 4:40 PM
Details	340B ID	Update		ISDR-DSH070035	DSH070035	5/13/2013 10:19 AM
Dates	Participating Approval Date	Update			5/13/2013 12:00:00 AM	5/13/2013 10:19 AM
Details	State	Update		Pending	Active	5/13/2013 10:19 AM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	5/13/2013 10:19 AM
Details	340B ID	Update		DR041013B	ISDR-DSH070035	4/19/2013 2:41 PM
Details	340B ID	Update		ONLINE_REG	DR041013B	4/10/2013 9:02 PM
Details	Last Recertification Date	Insert				4/10/2013 12:15 PM
Details	Grant Number	Insert				4/10/2013 12:15 PM
Details	340B ID	Insert			ONLINE_REG	4/10/2013 12:15 PM
Details	Is Authorizing Official EHB Data	Insert				4/10/2013 12:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/10/2013 12:15 PM
Details	Medicare Provider Number	Insert			070035	4/10/2013 12:15 PM
Details	Entity Name	Insert			The Hospital of Central Connecticut	4/10/2013 12:15 PM
Details	Program Code	Insert			DSH	4/10/2013 12:15 PM
Details	Entity Subname	Insert				4/10/2013 12:15 PM
Dates	Participating Approval Date	Insert				4/10/2013 12:15 PM
Details	State	Insert			Pending	4/10/2013 12:15 PM
Dates	Registration Date	Insert			4/10/2013 12:00:00 AM	4/10/2013 12:15 PM
Dates	Signed By Date	Insert			4/10/2013 12:00:00 AM	4/10/2013 12:15 PM
Dates	Start Date	Insert				4/10/2013 12:15 PM
Terminations	Termination Comments	Insert				4/10/2013 12:15 PM
Terminations	Termination Date	Insert				4/10/2013 12:15 PM
Terminations	Termination Effective Date	Insert				4/10/2013 12:15 PM
Terminations	Termination Reason	Insert				4/10/2013 12:15 PM