340B Drug Pricing Program Database


DSH070025 HARTFORD HOSPITAL (Active) - information as of 6/15/2025 6:09:12 AM

Main Details
HARTFORD HOSPITAL
Disproportionate Share Hospital
Yes
DSH070025
070025


Additional Details
Active
4/4/2016
7/1/2016
4/20/2016
9/3/2024

Contacts

Hartford Healthcare
Sean Michael Curtin, Vice President, Finance, Hartford Region
(860) 545-0585

Hartford Hospital
Eric Arlia, Director of Pharmacy
(860) 972-4165

Addresses

80 SEYMOUR STREET
HARTFORD, CT 06102

Hartford Hospital
PO BOX 5037
Attn: Accounts Payable
Hartford, CT 06102


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CT4041869,4025151,0080572221902834880,1770696643,1790183515
Shipping Addresses

Hartford Hospital
80 Seymour Street
Hartford, CT 06102

HH Community Pharmacy
85 Seymour Street
STE 105
Hartford, CT 06106

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

West Hartford Surgery Center
65 Memorial Road
Suite 500
West Hartford, CT 06107
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/15/201610/01/2016  08/19/2016
Contract DetailACCREDO HEALTH GROUP INC201 GREAT CIRCLE ROAD
NASHVILLETN3722807/15/201610/01/2016 09/01/202309/26/2023
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/15/201610/01/2016  08/19/2016
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201010/17/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/15/201610/01/2016 06/01/202309/26/2023
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/15/201610/01/2016  08/19/2016
Contract DetailACCREDO HEALTH GROUP, INC.  PHARMACY
2 BOULDEN CIRCLE SUITE 1 		NEW CASTLEDE1972007/15/201610/01/2016  08/19/2016
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267010/17/202301/01/2024  01/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526110/17/202301/01/2024  01/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771310/17/202301/01/2024  01/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620307/15/202410/01/2024  10/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/15/201910/01/2019  10/01/2019
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/15/201910/01/2019  10/01/2019
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/15/201910/01/2019  10/01/2019
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/15/201910/01/2019  10/01/2019
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/18/202304/01/2023  04/01/2023
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/15/201910/01/2019  10/01/2019
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/18/202304/01/2023  04/01/2023
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/18/202304/01/2023  04/01/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/18/202304/01/2023  04/01/2023
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911901/18/202304/01/2023  04/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02153 150 SOUTH MAIN STREET
WEST HARTFORDCT0610707/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01903 824 PARK AVE
BLOOMFIELDCT0600207/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01948 690 WETHERSFIELD AVE.
HARTFORDCT0611407/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00349 484 WINDSOR AVENUE
WINDSORCT0609507/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01202 20 BANK ST.
GRANBYCT0603507/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02525 323 CROMWELL AVENUE
ROCKY HILLCT0606707/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00671 1099 NEW BRITAIN AVENUE
WEST HARTFORDCT0611007/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10130 110 MAIN STREET
HEBRONCT0624807/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01038 1044 BOULEVARD
WEST HARTFORDCT0611907/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00691 1181 MAIN STREET
NEWINGTONCT0611107/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04436 241 MIDDLE TURNPIKE WEST
MANCHESTERCT0604007/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00459 2639 MAIN STREET
GLASTONBURYCT0603307/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01070 90 MAIN STREET
WINDSOR LOCKSCT0609607/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05450 766 NEW LONDON TURNPIKE
GLASTONBURYCT0603307/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02219 2427 MAIN STREET
ROCKY HILLCT0606707/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00840 908-910 MAPLE AVENUE
HARTFORDCT0611407/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00231 142 TALCOTTVILLE ROAD
VERNONCT0606607/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01102 341 COTTAGE GROVE RD.
BLOOMFIELDCT0600207/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 5263 150 WASHINGTON STREET
HARTFORDCT0610607/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00348 1078 SILAS DEANE HIGHWAY
WETHERSFIELDCT0610907/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01043 525 BUCKLAND RD.
SOUTH WINDSORCT0607407/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #11072 344 N MAIN ST
WEST HARTFORDCT0611707/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01098 47 HAZARD AVE
ENFIELDCT0608207/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01166 219 BROAD STREET
WINDSORCT0609507/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01242 714 HOPMEADOW ST.
DRACUT MALL 		SIMSBURYCT0607007/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01156 1240 FARMINGTON AVENUE
WEST HARTFORDCT0610707/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01089 20 BURNSIDE AVENUE
EAST HARTFORDCT0610807/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01101 16 MAIN ST.
EAST HARTFORDCT0611807/15/201910/01/2019  10/01/2019
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00294 177 COLUMBUS BLVD.
NEW BRITAINCT0605104/15/202007/01/2020  07/01/2020
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00760 713 WEST MAIN STREET
NEW BRITAINCT0605304/15/202007/01/2020  07/01/2020
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00350 566 FARMINGTON AVENUE
HARTFORDCT0610504/15/202007/01/2020 05/01/202309/26/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02099 479 BLUE HILLS AVE.
HARTFORDCT0611204/15/202007/01/2020  07/01/2020
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01180 358 W. MAIN ST,
AVONCT0600104/21/202107/01/2021  07/01/2021
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 85 972 SILVER LN.
EAST HARTFORDCT0611804/21/202107/01/2021  07/01/2021
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 05848 119 S. MAIN ST.
COLCHESTERCT0641504/21/202107/01/2021  07/01/2021
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01027 372 WEST MAIN STREET
NORWICHCT0636010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01060 326 MAIN STREET
SOUTHINGTONCT0648910/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.CVS/PHARMACY # 5703 60 MIDDLE ST.
BRISTOLCT0601010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01183 777 MAIN STREET
HARTFORDCT0610310/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01125 10 LATHROP RD
PLAINFIELDCT0637410/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07916 292 SPIELMAN HWY.
BURLINGTONCT0601310/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00943 1200 MAIN STREET
WILLIMANTICCT0622610/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06807 153 BROAD STREET
MERIDENCT0645010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00785 632 MIDDLE TURNPIKE
STORRS MANSFIELDCT0626810/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00364 308 MAIN STREET EXTENSION
MIDDLETOWNCT0645710/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01153 1875 BOSTON AVE, CVS PLAZA
BRIDGEPORTCT0661010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02143 3710 MAIN STREET
BRIDGEPORTCT0660610/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 04149 54 EAST HIGH ST.
EAST HAMPTONCT0642410/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01960 1279 WEST MAIN STREET
WATERBURYCT0670810/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY #10316 1221 MAIN STREET
MANCHESTERCT0604010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00822 40 EAST ST.
NEW MILFORDCT0677610/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01276 81 NORTH STREET
BRISTOLCT0601010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01284 17 WEST MAIN STREET
CLINTONCT0641310/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00145 330 MAIN STREET
FARMINGTONCT0603210/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00696 14 CANDLEWOOD LAKE RD.
BROOKFIELDCT0680410/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00288 839 FARMINGTON AVE
BRISTOLCT0601010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01097 661 MAIN STREET
TORRINGTONCT0679010/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02022 163 MOUNTAIN RD
SUFFIELDCT0607810/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02018 540 WEST MAIN STREET
MERIDENCT0645110/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 935 891 NORTH COLONY RD.
WALLINGFORDCT0649210/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02109 22 WINDSOR AVE
VERNON ROCKVILLECT0606610/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00750 875 ENFIELD ST.
ENFIELD PLAZA SHOPPES 		ENFIELDCT0608210/08/202101/01/2022  01/01/2022
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00333 978 FARMINGTON AVENUE
WEST HARTFORDCT0610710/11/202201/01/2023 09/20/202309/26/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02119 1055 FARMINGTON AVENUE
KENSINGTONCT0603710/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00839 14 FARMINGTON AVENUE
PLAINVILLECT0606210/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02896 675 WASHINGTON STREET
MIDDLETOWNCT0645710/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02682 47 MAIN ST.
WINSTEDCT0609810/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00718 24 PERSHING DR # 36
ANSONIACT06401-221410/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02056 25 BROADWAY
MYSTICCT0635510/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00865 839 EAST MAIN STREET
MERIDENCT0645010/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00135 266 WEST STREET, ROUTE 202
LITCHFIELDCT0675910/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00916 26 DAVIS STREET
OAKVILLECT0677910/11/202201/01/2023  01/01/2023
Contract DetailCONNECTICUT CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02220 3514 MAIN ST.
COVENTRYCT0623801/18/202304/01/2023  04/01/2023
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/21/202107/01/2021  07/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/21/202107/01/2021  07/01/2021
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00859 287 SPRINGFIELD STREET
AGAWAMMA0100110/08/202101/01/2022  01/01/2022
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00769 217 NORTH MAIN STREET
EAST LONGMEADOWMA0102810/11/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00447 366 KING ST.
NORTHAMPTONMA0106010/11/202201/01/2023  01/01/2023
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502801/18/202304/01/2023  04/01/2023
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503304/15/201907/01/2019  07/01/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268304/21/202107/01/2021  07/01/2021
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654110/17/202301/01/2024  01/01/2024
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111201/14/202204/01/2022  04/01/2022
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313401/14/202204/01/2022  04/01/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801601/14/202204/01/2022  04/01/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607501/14/202204/01/2022  04/01/2022
Contract DetailOPTION CARE ENTERPRISES, INC.OPTION CARE 870 N. ARLINGTON HEIGHTS RD
SUITE 101 		ITASCAIL6014304/15/202007/01/2020  07/01/2020
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 100 TRAP FALLS RD
SUITE 200 		SHELTONCT0648404/15/202007/01/2020  07/01/2020
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 11403 BLUEGRASS PARKWAY
SUITE 400 		LOUISVILLEKY40299-239804/15/202007/01/2020  07/01/2020
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/17/202301/01/2024  01/01/2024
Contract DetailOPTUM FRONTIER THERAPIES, LLC325 W ATHERTON RD SUITE 1
FLINTMI48507-260110/17/202301/01/2024  01/01/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/21/202107/01/2021  07/01/2021
Contract DetailOPTUM INFUSION SERVICES 500, INC.33 N PLAINS INDUSTRIAL RD STE B
WALLINGFORDCT06492-584104/21/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/21/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/05/202204/13/2022  04/19/2022
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520401/16/202504/01/2025  04/01/2025
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/21/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621904/21/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/21/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110104/21/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140104/21/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/21/202107/01/2021  07/01/2021
Contract DetailOPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660804/21/202107/01/2021 05/27/202210/11/2022
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/21/202107/01/2021  07/01/2021
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999204/15/201907/01/2019 10/01/202210/11/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/15/201910/01/2019  10/01/2019
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY # 2516 35 KNEELAND STREET
BOSTONMA0211104/21/202107/01/2021  07/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920301/18/202304/01/2023  04/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681301/18/202304/01/2023  04/01/2023
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/18/202304/01/2023  04/01/2023
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255010/17/202301/01/2024  01/01/2024
Contract DetailRITE AID OF CONNECTICUT, INC.RITE AID #4620 744 WOLCOTT ROAD
WOLCOTTCT0671601/18/202304/01/2023  04/01/2023
Contract DetailRITE AID OF CONNECTICUT, INC.RITE AID #576 605 NORTH COLONY ROAD
WALLINGFORDCT0649201/18/202304/01/2023  04/01/2023
Contract DetailRITE AID OF CONNECTICUT, INC.RITE AID #1087 180 MAIN STREET
CHESHIRECT0641001/18/202304/01/2023  04/01/2023
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500210/17/202301/01/2024  01/01/2024
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301310/17/202301/01/2024  01/01/2024
Contract DetailTHE STOP & SHOP SUPERMARKETDBA STOP & SHOP PHARMACY #674 1391 MAIN STREET
WILLIMANTICCT0622610/16/202001/01/2021  01/01/2021
Contract DetailTHE STOP & SHOP SUPERMARKT CODBA STOP & SHOP PHARMACY #693 CHARTER OAK MALL
940 SILVER LANE 		EAST HARTFORDCT0611810/16/202001/01/2021  01/01/2021
Contract DetailTHE STOP & SHOP SUPERMARKT CODBA STOP & SHOP PHARMACY #631 215 GLASTONBURY BLVD
GLASTONBURYCT0603310/16/202001/01/2021  01/01/2021
Contract DetailTHE STOP & SHOP SUPERMARKT CODBA: STOP & SHOP PHCY #615 42 TOWN STREET
NORWICHCT0636010/16/202001/01/2021 12/23/202301/15/2024
Contract DetailTHE STOP & SHOP SUPERMARKT CODBA STOP & SHOP PHARMACY #619 1095 KENNEDY RD
WINDSORCT0609510/16/202001/01/2021 12/23/202301/15/2024
Contract DetailTHE STOP & SHOP SUPERMARKT CODBA STOP & SHOP PHARMACY#638 930 NORTH COLONY ROAD
WALLINGFORDCT0649210/16/202001/01/2021  01/01/2021
Contract DetailTHE STOP & SHOP SUPERMARKT CODBA STOP & SHOP PHARMACY #610 1380 BERLIN TURNPIKE
WETHERSFIELDCT0610910/16/202001/01/2021  01/01/2021
Contract DetailTHE STOP & SHOP SUPERMARKT CODBA STOP & SHOP PHARMACY#630 44 FENN ROAD
NEWINGTONCT0611110/16/202001/01/2021 12/23/202301/15/2024
Contract DetailUMASS MEMORIAL MEDICAL CENTER, INC.UMASS MEMORIAL MEDICAL CENTER SPECIALTY 55 LAKE AVE N
ACC BUILDING - 1ST FLOOR - SUITE AC1.033 		WORCESTERMA01655-000207/15/201610/01/2016 10/01/202210/11/2022
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/21/202107/01/2021  07/01/2021
Contract DetailWAL-MART PHARMACY 10-1891420 BUCKLAND HILLS DR
MANCHESTERCT0604204/21/202107/01/2021  07/01/2021
Contract DetailWAL-MART PHARMACY 10-2022474 BOSTON POST RD
NORTH WINDHAMCT0625604/21/202107/01/2021  07/01/2021
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/21/202107/01/2021  07/01/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05407 295 MAIN STREET
MANCHESTERCT0604004/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05134 540 BUSHY HILL ROAD
SIMSBURYCT0607004/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #10119 980 FARMINGTON AVE
BERLINCT0603704/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07641 359 MAIN ST
SOUTHINGTONCT06489-453804/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04490 1100 SILAS DEANE HWY
WETHERSFIELDCT0610904/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01824 30 HAZARD AVE
ENFIELDCT0608204/15/201907/01/2019 07/20/202008/14/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09784 20 CONNECTICUT BLVD
EAST HARTFORDCT06108-300704/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 11825 525 FARMINGTON AVENUE
BRISTOLCT0601004/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #11533 1312 MANCHESTER RD
GLASTONBURYCT06033-182404/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07750 940 S QUAKER LN
WEST HARTFORDCT0611004/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02976 399 WEST MAIN
NORWICHCT0636004/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06654 149 DEMING STREET
MANCHESTERCT06042-173104/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07566 922 SILVER LANE
EAST HARTFORDCT0611804/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21185 100 RETREAT AVE STE 105
HARTFORDCT0610604/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07047 2920 BERLIN TURNPIKE
NEWINGTONCT06111-411604/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #15389 5 MILL STREET
UNIONVILLECT06085-101904/15/201907/01/2019 06/01/202007/15/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21180 60 BANK ST STE 100
WATERBURYCT0670204/15/201907/01/2019 06/18/201906/18/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #09746 1 ELM ST
WINDSOR LOCKSCT0609604/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03827 161 WASHINGTON ST
HARTFORDCT0610604/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #15207 668 FARMINGTON AVE
WEST HARTFORDCT0611904/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07333 1475 MAIN STREET
WILLIMANTICCT06226-191404/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #11919 1630 BOSTON TPKE
COVENTRYCT0623804/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06992 529 TALCOTTVILLE RD
VERNON ROCKVILLECT06066-231104/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #16548 300 FAIRFIELD AVE STE 103
BRIDGEPORTCT0660404/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #11604 220 ALBANY TURNPIKE CANTON VILLAGE
ROUTE #44 		CANTONCT0601904/15/201907/01/2019 02/19/202404/17/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05948 425 W MAIN ST
MERIDENCT0645104/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01977 188 UNION ST
VERNONCT06066-242904/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09432 2 SHAKER ROAD
ENFIELDCT06082-311204/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07585 102 WASHINGTON STREET
NEW BRITAINCT06051-182604/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #02228 2900 MAIN ST
GLASTONBURYCT06033-102704/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #9818 4 HAMMERHEAD PL
CROMWELLCT0641604/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01826 324 N MAIN ST
WEST HARTFORDCT0611704/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07086 5 FARMINGTON AVE
PLAINVILLECT06062-172604/15/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21180 60 BANK ST STE 100
WATERBURYCT0670206/18/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #13969 55 PARK ST STE 1A
NEW HAVENCT0651110/12/202201/01/2023  01/01/2023
Contract DetailWALGREENS MAIL SERVICE, LLCWALGREENS MAIL SERVICE #03397 8350 S RIVER PARKWAY
TEMPEAZ8528404/15/201907/01/2019  07/01/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700804/15/201907/01/2019 10/01/202109/26/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527504/15/201907/01/2019  07/01/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503304/15/201907/01/2019  07/01/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818804/15/201907/01/2019  07/01/2019
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH070025AChildDSHHARTFORD HOSPITALRehab West Hartford445 South Main StWest HartfordCTTerminated
DSH070025AAChildDSHHARTFORD HOSPITALInstitute of Living - OPD Adult Psych Clinic200 Retreat StreetHartfordCTActive
DSH070025ABChildDSHHARTFORD HOSPITALHH IOL DBT MH PHP 101067031 - 90.05200 Retreat StreetHartfordCTActive
DSH070025ACChildDSHHARTFORD HOSPITALInstitute of Living - Psychological Testing200 Retreat StreetHartfordCTTerminated
DSH070025ADChildDSHHARTFORD HOSPITALHH IOL OPD Institute Psych Group 101067049 - 90.05200 Retreat StreetHartfordCTActive
DSH070025AEChildDSHHARTFORD HOSPITALHH IOL SCHIZRHB MH OP 101067045 - 90.05200 Retreat StreetHartfordCTTerminated
DSH070025AFChildDSHHARTFORD HOSPITALInstitute of Living - Electro Convulsive Therapy200 Retreat StreetHartfordCTActive
DSH070025AGChildDSHHARTFORD HOSPITALInstitute of Living - PHP Young Adult Therapy200 Retreat StreetHartfordCTActive
DSH070025AHChildDSHHARTFORD HOSPITALInstitute of Living - TOPS Extended Day Program200 Retreat StreetHartfordCTActive
DSH070025AJChildDSHHARTFORD HOSPITALInstitute of Living - OPD Child Adolescent Psych Clinic200 Retreat StreetHartfordCTActive
DSH070025AKChildDSHHARTFORD HOSPITALHH IOL CHL ADO DAY PHP 101039009 - 90.05200 Retreat StreetHartfordCTActive
DSH070025ALChildDSHHARTFORD HOSPITALHH IOL PROF PRG MH PHP 101067025 - 90.05200 Retreat StreetHartfordCTActive
DSH070025AMChildDSHHARTFORD HOSPITALHH IOL ADUL DAY MH PHP 101067020 - 90.05200 Retreat StreetHartfordCTActive
DSH070025ANChildDSHHARTFORD HOSPITALHH IOL EATING D MH PHP 101067016 - 90.05200 Retreat StreetHartfordCTTerminated
DSH070025APChildDSHHARTFORD HOSPITALHH MED ONC CI HTFD 101025008 - 55.0085 Retreat AveHartfordCTActive
DSH070025AQChildDSHHARTFORD HOSPITALHelen & Harry Gray Cancer Center - Medical Physics85 Retreat AveHartfordCTTerminated
DSH070025ARChildDSHHARTFORD HOSPITALHH RADONC 101025003 - 55.0085 Retreat AveHartfordCTActive
DSH070025ASChildDSHHARTFORD HOSPITALBrownstone Building - OPD Dental Clinic79 Retreat AveHartfordCTTerminated
DSH070025ATChildDSHHARTFORD HOSPITALHH SS GEN SURGERY 101021016 - 90.0685 Seymour St.HartfordCTTerminated
DSH070025AUChildDSHHARTFORD HOSPITALHH CARDIOLOGY CLINIC 101018002 - 69.0079 Retreat AveHartfordCTActive
DSH070025AVChildDSHHARTFORD HOSPITALHH CARDIOLOGY OUTPATIENT VAD 101017003 - 69.0085 Seymour St.HartfordCTActive
DSH070025AWChildDSHHARTFORD HOSPITALHH NEUROLOGY CLINIC 101018047 - 66.0179 Retreat AveHartfordCTActive
DSH070025AXChildDSHHARTFORD HOSPITALHH COMM CARE CLINIC 101018046 - 90.00132 Jefferson StreetHartfordCTActive
DSH070025AYChildDSHHARTFORD HOSPITALHH ADULT PRIM CARE 101018045 - 90.00132 Jefferson StreetHartfordCTActive
DSH070025AZChildDSHHARTFORD HOSPITALHH HEART RHYTHM SRV HT 101017005 - 69.0085 Jefferson StreetHartfordCTActive
DSH070025BChildDSHHARTFORD HOSPITALHH PHYS MED REHAB FARM 101060002 - 66.00406 Farmington AveFarmingtonCTActive
DSH070025BAChildDSHHARTFORD HOSPITALHH CHOLESTEROL MGT CTR 101017016 - 69.0085 Jefferson StreetHartfordCTActive
DSH070025BBChildDSHHARTFORD HOSPITALCardiac Rehab85 Seymour StHartfordCTTerminated
DSH070025BCChildDSHHARTFORD HOSPITALHH INFUSION 101025006 - 55.00Helen & Harry Gray Cancer Center, 85 Retreat AveHartfordCTActive
DSH070025BDChildDSHHARTFORD HOSPITALHH MAT FETAL MED HTFD 101016159 - 90.0385 Jefferson StreetHartfordCTActive
DSH070025BEChildDSHHARTFORD HOSPITALHH CF ADULT CENTER 101018043 - 65.0079 Retreat AveHartfordCTActive
DSH070025BFChildDSHHARTFORD HOSPITALHH CHCD 101017003 - 90.0085 Jefferson StreetHartfordCTActive
DSH070025BGChildDSHHARTFORD HOSPITALHH ENDOCRINE CLINIC 101018008 - 90.0279 Retreat AveHartfordCTActive
DSH070025BHChildDSHHARTFORD HOSPITALHH GYNONC HTFD 101021003 - 90.0385 Seymour StreetHartfordCTActive
DSH070025BJChildDSHHARTFORD HOSPITALRehab Hartford85 Jefferson StreetHartfordCTTerminated
DSH070025BKChildDSHHARTFORD HOSPITALHH PHYS MED REHAB HFD 101021006 - 66.0085 Seymour StreetHartfordCTActive
DSH070025BLChildDSHHARTFORD HOSPITALHH MRI 101017009 - 58.0085 Jefferson StreetHartfordCTActive
DSH070025BMChildDSHHARTFORD HOSPITALHH PULMONARY LAB 101016110 - 65.0085 Jefferson StreetHartfordCTActive
DSH070025BNChildDSHHARTFORD HOSPITALRehab Wallingford85 Barnes RoadWallingfordCTTerminated
DSH070025BPChildDSHHARTFORD HOSPITALWest Hartford Surgery Center65 Memorial RoadWest HartfordCTActive
DSH070025BQChildDSHHARTFORD HOSPITALRehab Blueback65 Memorial RoadWest HartfordCTTerminated
DSH070025BRChildDSHHARTFORD HOSPITALHH BJI RHEUMATOLOGY 101021009 - 90.0831 Seymour St.HartfordCTActive
DSH070025BSChildDSHHARTFORD HOSPITALWHS Urogynecology85 Jefferson StreetHartfordCTTerminated
DSH070025BTChildDSHHARTFORD HOSPITALHH GI ENDOSCOPY 101017012 - 050.0185 Jefferson StreetHartfordCTActive
DSH070025BUChildDSHHARTFORD HOSPITALHH VASCULAR LABORATORY 101017011 - 65.0285 Jefferson StreetHartfordCTActive
DSH070025BVChildDSHHARTFORD HOSPITALHH PULMONARY REHAB 101016111 - 65.0085 Jefferson StreetHartfordCTActive
DSH070025BWChildDSHHARTFORD HOSPITALCardiac Rehab Glastonbury305 Western BlvdGlastonburyCTTerminated
DSH070025BXChildDSHHARTFORD HOSPITALWest Hartford Surgery Center - Blue Back Square65 Memorial RoadWest HartfordCTActive
DSH070025BYChildDSHHARTFORD HOSPITALHH Eye Surgery Center505 Willard AveNewingtonCTTerminated
DSH070025BZChildDSHHARTFORD HOSPITALHH NEURSCN MOB 101021030 - 60.0185 Seymour StreetHartfordCTActive
DSH070025CChildDSHHARTFORD HOSPITALRehab Bishops Corner334 North Main StreetWest HartfordCTTerminated
DSH070025CAChildDSHHARTFORD HOSPITALOutpatient Dialysis85 Jefferson StreetHartfordCTTerminated
DSH070025CBChildDSHHARTFORD HOSPITALHH TRANSPLANT 101021023 - 107.0085 Seymour StreetHartfordCTActive
DSH070025CCChildDSHHARTFORD HOSPITALHH AWLC UROGYN BLBK 101022015 - 90.0365 MEMORIAL RDWEST HARTFORDCTActive
DSH070025CDChildDSHHARTFORD HOSPITALHH MED ONC CI JB HTFD 101021038 - 55.0085 Jefferson StreetHARTFORDCTActive
DSH070025CEChildDSHHARTFORD HOSPITALHH INFUSION AVON 101024008 - 055.0180 FISHER DRIVEAVONCTActive
DSH070025CFChildDSHHARTFORD HOSPITALHH MED ONC CI AVON 101024009 - 055.0180 Fisher Dr.AvonCTActive
DSH070025CGChildDSHHARTFORD HOSPITALHH INFUSION MANCH 100119002 - 055.02376 Tolland TurnpikeManchesterCTActive
DSH070025CHChildDSHHARTFORD HOSPITALHH PHYS MED REHAB VERN 101081006 - 66.0035 Talcotville RdVernonCTActive
DSH070025CJChildDSHHARTFORD HOSPITALHH ENT CLINIC 101018009 - 90.0079 Retreat AveHartfordCTActive
DSH070025CKChildDSHHARTFORD HOSPITALHH PHYS MED REHAB 815 101021032 - 66.0185 Seymour StHartfordCTActive
DSH070025CLChildDSHHARTFORD HOSPITALHH UROLOGY CLINIC 101018018 - 90.0079 Retreat AveHartfordCTActive
DSH070025CMChildDSHHARTFORD HOSPITALHH PULMONOLOGY CLINIC 101018015 - 90.0079 Retreat AveHartfordCTActive
DSH070025CNChildDSHHARTFORD HOSPITALHH PHYS MED REHAB BJI 101016216 - 66.0032 Seymour StHartfordCTActive
DSH070025CPChildDSHHARTFORD HOSPITALHH PHYS MED & REHAB GLAST 101020003 - 66.00330 Western BlvdGlastonburyCTActive
DSH070025CQChildDSHHARTFORD HOSPITALHH GI Clinic 101018010 - 90.0079 Retreat AveHartfordCTActive
DSH070025CRChildDSHHARTFORD HOSPITALOncology-Infusion _Manchester 55.02 HH GYNONC MANCH 101119004376 Tolland TurnpikeManchesterCTActive
DSH070025CSChildDSHHARTFORD HOSPITALOncology-Infusion _Manchester 55.02 HH MED ONC CI MANCH 101119001376 Tolland TurnpikeManchesterCTActive
DSH070025CTChildDSHHARTFORD HOSPITALRadiology Therapeutic 55.00 HH INFUSION JB85 JEFFERSON STREEETHartfordCTActive
DSH070025CUChildDSHHARTFORD HOSPITALHH DIABETES LC HTFD - Endocrinology85 Seymour StHartfordCTActive
DSH070025CVChildDSHHARTFORD HOSPITALClinic 90.00 HH SS OPHTHALMOLOGY 10102102579 Retreat AvehartfordCTActive
DSH070025CWChildDSHHARTFORD HOSPITALEMG/Physiatry 66.01 HH NEUROLOGY SPORTS32 10101621932 Seymour StHartfordCTTerminated
DSH070025CXChildDSHHARTFORD HOSPITALEMG/Physiatry 66.01 HH NEUROLOGY SPORTS31 10101622031 Seymour StHartfordCTTerminated
DSH070025CYChildDSHHARTFORD HOSPITALCardiology-EKG 69.00 HH HEART RHYTHM SRV WH 101022003 - Cardiology65 Memorial RoadWest HartfordCTActive
DSH070025CZChildDSHHARTFORD HOSPITALPhysical Therapy 66.00 HH PHYS MED REHAB BLBK 101022020 - Physical Therapy65 Memorial RoadWest HartfordCTActive
DSH070025DChildDSHHARTFORD HOSPITALHH AWLC UROGYN GLAST 101013004 - 90.03330 Western BlvdGlastonburyCTActive
DSH070025DAChildDSHHARTFORD HOSPITALHepatology Clinic 090.07 HH HEPATOLOGY WINDHAM 101083001 - Hepatology112 Mansfield AvenueWillimanticCTActive
DSH070025DBChildDSHHARTFORD HOSPITALBJI CLINIC 90.08 HH BJI RHEUM INFUSION 101021037 - BJI Clinic31 Seymour St.HartfordCTActive
DSH070025DCChildDSHHARTFORD HOSPITALPSYCH CLINICS 90.05 HH IOL ESKETAMINE CTR 101067062 - Psych Clinic200 Retreat Street, Burlingame BuildingHartfordCTActive
DSH070025DDChildDSHHARTFORD HOSPITALPSYCH CLINICS 90.05 HH IOL INST PSY PERI 101067054 - Psych Clinic200 Retreat St, West Grad BuildinghartfordCTActive
DSH070025DEChildDSHHARTFORD HOSPITALPSYCH CLINICS 90.05 HH IOL SA MATCH - Psych Clinic200 Retreat Street Thompson BuildingHartfordCTActive
DSH070025DFChildDSHHARTFORD HOSPITALPhysical Therapy 066.00 HH PHYS MED NEURONC 101016865 - Physical Therapy85 Seymour StreetHartfordCTActive
DSH070025DGChildDSHHARTFORD HOSPITALPHP Schizophrenia Rehab 90.05 HH IOL SRP PHP 101067045 - Psych Clinic200 Retreat StHartfordCTActive
DSH070025DHChildDSHHARTFORD HOSPITALHH NEURO ONC HTFD85 - Neuro Oncology85 Retreat AvenueHartfordCTActive
DSH070025DJChildDSHHARTFORD HOSPITALHH NEURO STROKE MOB - Neurology-Stroke85 Seymour StreetHartfordCTActive
DSH070025DKChildDSHHARTFORD HOSPITALHH SS BREAST CLINIC - Breast Clinic79 Retreat AvenueHartfordCTActive
DSH070025DLChildDSHHARTFORD HOSPITALHH GERIATRIC CLINIC - Geriatrics79 Retreat AvenueHartfordCTActive
DSH070025DMChildDSHHARTFORD HOSPITALHH TRAUMA CLINIC - Trauma79 Retreat AvenueHartfordCTActive
DSH070025DNChildDSHHARTFORD HOSPITALHH ADDICTION MED - Addiction Medicine79 Retreat AvenueHartfordCTActive
DSH070025DPChildDSHHARTFORD HOSPITALHH NEUROMUSCULAR MOB - Neuromuscular85 Seymour StreetHartfordCTActive
DSH070025DQChildDSHHARTFORD HOSPITALHH WHSC GI CENTER - GI CLINIC65 MEMORIAL RDWEST HARTFORDCTActive
DSH070025DRChildDSHHARTFORD HOSPITALHH PHYS MED REHAB HARTFORD79 - REHAB79 RETREAT AVENUEHARTFORDCTActive
DSH070025DSChildDSHHARTFORD HOSPITALHH MOVEMENT DISORDER SPAN HTFD - MOVEMENT DISORDER85 SEYMOUR STREETHARTFORDCTActive
DSH070025DTChildDSHHARTFORD HOSPITALHH ARRHYTHMIA WEST HARTFORD - ARRHYTHMIA65 MEMORIAL ROADWEST HARTFORDCTActive
DSH070025DUChildDSHHARTFORD HOSPITALHH ARRHYTHMIA HTFD - ARRHYTHMIA85 JEFFERSON STREETHARTFORDCTActive
DSH070025DVChildDSHHARTFORD HOSPITALHH NEURODIAGNOSTIC MOB - NEUROLOGY85 SEYMOUR STREETHARTFORDCTActive
DSH070025DWChildDSHHARTFORD HOSPITALHH ENDO NEOPLASIA - ENDOCRINOLOGY79 RETREAT AVENUEHARTFORDCTActive
DSH070025DXChildDSHHARTFORD HOSPITALHH ENDO BONE - ENDOCRINOLOGY79 RETREAT AVENUEHARTFORDCTActive
DSH070025DYChildDSHHARTFORD HOSPITALHH ENDO THYROID - ENDOCRINE79 RETREAT AVENUEHARTFORDCTActive
DSH070025DZChildDSHHARTFORD HOSPITALHH TRANSITIONAL CARE - TRANSITIONAL CARE79 RETREAT AVENUEHARTFORDCTActive
DSH070025EChildDSHHARTFORD HOSPITALRehab Glastonbury330 Western BlvdGlastonburyCTTerminated
DSH070025EAChildDSHHARTFORD HOSPITALHH HEADACHE CTR BLBK - HEADACHE CENTER65 MEMORIAL ROADWEST HARTFORDCTActive
DSH070025EBChildDSHHARTFORD HOSPITALHH COMMUNITY CARE PSYCH - PSYCHIATRY132 JEFFERSON STREETHARTFORDCTActive
DSH070025ECChildDSHHARTFORD HOSPITALHH BEHAVIORAL HEALTH HARTFORD 132 - BEHAVIORAL HEALTH132 JEFFERSON STREETHARTFORDCTActive
DSH070025EDChildDSHHARTFORD HOSPITALHH INFECTIOUS DISEASE - INFECTIOUS DISEASE132 JEFFERSON STREETHARTFORDCTActive
DSH070025EEChildDSHHARTFORD HOSPITALHH AWLC FAC PRACT BLBK - WOMENS HEALTH65 MEMORIAL ROADWEST HARTFORDCTActive
DSH070025EFChildDSHHARTFORD HOSPITALHH AWLC GYNONC BLBK - WOMENS HEALTH65 MEMORIAL ROADWEST HARTFORDCTActive
DSH070025EGChildDSHHARTFORD HOSPITALHH BEH HLTH WMNS WH65 - BEHAVIORAL HEALTH65 MEMORIAL ROADWEST HARTFORDCTActive
DSH070025EHChildDSHHARTFORD HOSPITALHH EPILEPSY HTFD 85 - EPILEPSY85 SEYMOUR STREETHARTFORDCTActive
DSH070025EJChildDSHHARTFORD HOSPITALHH PAIN PSYCH CTR WH - PSYCH65 MEMORIAL ROADWEST HARTFORDCTActive
DSH070025EKChildDSHHARTFORD HOSPITALHH LDL APHERESIS - CHOLESTEROL MANAGEMENT85 JEFFERSON STREETHARTFORDCTActive
DSH070025ELChildDSHHARTFORD HOSPITALHH IOL SRP OP - PSYCH- SCHIZOPHRENIA REHAB200 RETREAT AVEHARTFORDCTApproved
DSH070025EMChildDSHHARTFORD HOSPITALHH GYN SPECIALTIES BLBK - GYNECOLOGY65 MEMORIAL RDWEST HARTFORDCTApproved
DSH070025ENChildDSHHARTFORD HOSPITALHH IOL PROF PROGRAM IOP - PSYCH200 RETREAT AVEHARTFORDCTApproved
DSH070025EPChildDSHHARTFORD HOSPITALHH NEURO ONC HTFD SYMR - NEURO ONCOLOGY85 SEYMOUR STREETHARTFORDCTApproved
DSH070025EQChildDSHHARTFORD HOSPITALHH IOL AUT CHAD OP - PSYCH- AUTISM200 RETREAT AVEHARTFORDCTApproved
DSH070025ERChildDSHHARTFORD HOSPITALHH NEURO ONC JB HTFD - NEURO ONC85 JEFFERSON STREETHARTFORDCTApproved
DSH070025ESChildDSHHARTFORD HOSPITALHH IOL SA MATCH IOP - SUBSTACE ABUSE PSYCH200 RETREAT AVEHARTFORDCTApproved
DSH070025ETChildDSHHARTFORD HOSPITALHH GYN ONC BLBK - GYNECOLOGY ONCOLOGY65 MEMORIAL ROADWEST HARTFORDCTApproved
DSH070025EUChildDSHHARTFORD HOSPITALHH IOL INST PSY ADU OP - PSYCH - ADULT200 RETREAT AVEHARTFORDCTApproved
DSH070025EVChildDSHHARTFORD HOSPITALHH IOL OLDER ADULT OP - PSYCH200 RETREAT AVEHARTFORDCTApproved
DSH070025FChildDSHHARTFORD HOSPITALRehab Manchester252 North Main StManchesterCTTerminated
DSH070025GChildDSHHARTFORD HOSPITALRehab Granby18 East Granby RdGranbyCTTerminated
DSH070025HChildDSHHARTFORD HOSPITALHH PHYS MED & REHAB SW 101010004 - 66.001559 Sullivan AvenueSouth WindsorCTActive
DSH070025JChildDSHHARTFORD HOSPITALSleep Lab Wethersfield1260 Silas Deane HwyWethersfieldCTTerminated
DSH070025KChildDSHHARTFORD HOSPITALHH NEUROSCN WETH 101039008 - 70.001260 Silas Deane HwyWethersfieldCTTerminated
DSH070025LChildDSHHARTFORD HOSPITALWomens Ambulatory Health Services111 Park StreetHartfordCTActive
DSH070025MChildDSHHARTFORD HOSPITALNuclear Cardiology Farmington11 South RoadFarmingtonCTTerminated
DSH070025NChildDSHHARTFORD HOSPITALMeriden Rehab1064 East Main StMeridenCTTerminated
DSH070025PChildDSHHARTFORD HOSPITALWindsor Rehab1060 Day Hill RdWindsorCTTerminated
DSH070025QChildDSHHARTFORD HOSPITALWethersfield Rehab1260 SILAS DEANE HWYWETHERSFIELDCTTerminated
DSH070025RChildDSHHARTFORD HOSPITALAvon Cardiac Rehab100 SIMSBURY ROADAVONCTTerminated
DSH070025SChildDSHHARTFORD HOSPITALAvon Rehab100 SIMSBURY ROADAVONCTTerminated
DSH070025TChildDSHHARTFORD HOSPITALEnfield Rehab100 HAZARD AVENUEENFIELDCTTerminated
DSH070025UChildDSHHARTFORD HOSPITALHH RADONC AVON 101024002 - 55.0180 Fisher RoadAvonCTActive
DSH070025VChildDSHHARTFORD HOSPITALAvon Cancer Center Medical Physics80 Fisher RoadAvonCTTerminated
DSH070025WChildDSHHARTFORD HOSPITALHH SAME DAY ADMISSION 101016114 - 50.0085 Jefferson StreetHartfordCTActive
DSH070025XChildDSHHARTFORD HOSPITALSleep Lab Bloomfield533 Cottage Grove RdBloomfieldCTTerminated
DSH070025YChildDSHHARTFORD HOSPITALDuncaster Geriatric Services40 Loeffler Dr.BloomfieldCTTerminated
DSH070025ZChildDSHHARTFORD HOSPITALHH BJI ORTHO 101021010 - 90.0031 Seymour St.HartfordCTActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateProfile Change RequestCurtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 8602245194Curtin, Sean Michael Vice President, Finance, Hartford Region Hartford Healthcare 860545058512/26/2024 7:46 AM
DetailsLast Recertification DateUpdateRecertification8/30/2023 11:30:59 AM9/3/2024 12:43:01 PM9/3/2024 12:43 PM
AddressesBilling AddressInsertChange Request Hartford Hospital PO BOX 5037 Attn: Accounts Payable Hartford, CT 061022/11/2024 3:13 PM
ContactsAuthorizing OfficialUpdateAO Change RequestFichandler, David Senior Director, Clinical Operations Hartford Hospital 8609722450Curtin, Sean Michael Vice President, Finance, Central Region Hartford Healthcare 86022451941/11/2024 7:24 AM
AddressesMain AddressUpdateChange Request 80 SEYMOUR STREET STE 105 HARTFORD, CT 06102 80 SEYMOUR STREET HARTFORD, CT 0610211/14/2023 9:25 AM
AddressesShipping AddressUpdateChange RequestHH Community Pharmacy 85 Seymour Street Hartford, CT 06106HH Community Pharmacy 85 Seymour Street STE 105 Hartford, CT 0610611/14/2023 9:25 AM
AddressesMain AddressUpdateChange Request 80 SEYMOUR STREET HARTFORD, CT 06102 80 SEYMOUR STREET STE 105 HARTFORD, CT 0610211/3/2023 9:36 AM
DetailsLast Recertification DateUpdateRecertification8/25/2022 7:45:29 AM8/30/2023 11:30:59 AM8/30/2023 11:30 AM
DetailsLast Recertification DateUpdateRecertification8/30/2021 1:13:29 PM8/25/2022 7:45:29 AM8/25/2022 7:45 AM
ContactsAuthorizing OfficialUpdateAO Change RequestDrouin, Julie M VP of Finance Hartford Hospital 8605450585Fichandler, David Senior Director, Clinical Operations Hartford Hospital 86097224503/30/2022 1:37 PM
DetailsLast Recertification DateUpdateRecertification9/13/2020 4:43:25 PM8/30/2021 1:13:29 PM8/30/2021 1:13 PM
ContactsAuthorizing OfficialUpdateChange RequestBoisvert, Gerald Vice President, Finance Operations Hartford Hospital 8605450585Drouin, Julie M VP of Finance Hartford Hospital 86054505859/23/2020 8:00 AM
Medicaid BillingNPI: NumberInsertRecertification 19028348809/13/2020 4:43 PM
Medicaid BillingNPI: StateInsertRecertification CT9/13/2020 4:43 PM
Medicaid BillingNPI: NumberInsertRecertification 17706966439/13/2020 4:43 PM
Medicaid BillingNPI: StateInsertRecertification CT9/13/2020 4:43 PM
Medicaid BillingNPI: NumberInsertRecertification 17901835159/13/2020 4:43 PM
Medicaid BillingNPI: StateInsertRecertification CT9/13/2020 4:43 PM
Medicaid BillingNPI: NumberDeleteRecertification1902834880 ( ) 9/13/2020 4:43 PM
Medicaid BillingNPI: NumberDeleteRecertification1770696643 ( ) 9/13/2020 4:43 PM
Medicaid BillingNPI: NumberDeleteRecertification1790183515 ( ) 9/13/2020 4:43 PM
DetailsLast Recertification DateUpdateRecertification8/20/2019 1:08:07 PM9/13/2020 4:43:25 PM9/13/2020 4:43 PM
DetailsLast Recertification DateUpdateRecertification9/11/2018 12:39:44 PM8/20/2019 1:08:07 PM8/20/2019 1:08 PM
DetailsLast Recertification DateUpdateRecertification11/29/2017 6:50:09 PM9/11/2018 12:39:44 PM9/11/2018 12:39 PM
AddressesShipping AddressInsertChange Request West Hartford Surgery Center 65 Memorial Road Suite 500 West Hartford, CT 0610712/12/2017 9:13 AM
AddressesShipping AddressInsertChange Request Safecor Health, LLC 317 New Boston Street, Suite 100 Woburn, MA 0180112/4/2017 1:38 PM
DetailsLast Recertification DateUpdateRecertification8/30/2016 12:00:00 AM11/29/2017 6:50:09 PM11/29/2017 6:50 PM
ContactsAuthorizing OfficialUpdate Boisvert, Gerald Vice President, Finance Operations 8605450585Boisvert, Gerald Vice President, Finance Operations Hartford Hospital 860545058510/26/2017 9:08 AM
ContactsSigned ByUpdate Boisvert, Gerald Vice President, Finance Operations 8605450585Boisvert, Gerald Vice President, Finance Operations Hartford Hospital 860545058510/26/2017 9:08 AM
ContactsPrimary ContactUpdate Arlia, Eric Director of Pharmacy 8609724165Arlia, Eric Director of Pharmacy Hartford Hospital 86097241659/28/2017 8:18 AM
ContactsPrimary ContactInsert  Arlia, Eric Director of Pharmacy 86097241654/19/2017 5:34 PM
ContactsAuthorizing OfficialInsert  Boisvert, Gerald Vice President, Finance Operations 86054505854/19/2017 5:34 PM
ContactsSigned ByInsert  Boisvert, Gerald Vice President, Finance Operations 86054505854/19/2017 5:34 PM
AddressesMain AddressInsert   80 SEYMOUR STREET HARTFORD, CT 061028/30/2016 3:19 PM
DetailsLast Recertification DateUpdate  8/30/2016 12:00:00 AM8/30/2016 3:19 PM
AddressesShipping AddressInsert  Hartford Hospital 80 Seymour Street Hartford, CT 061028/19/2016 4:11 PM
AddressesShipping AddressInsert  HH Community Pharmacy 85 Seymour Street Hartford, CT 061068/19/2016 4:11 PM
DatesParticipating Approval DateUpdate  4/20/2016 12:00:00 AM4/20/2016 5:46 PM
DetailsStateUpdate PendingActive4/20/2016 5:46 PM
DatesStart DateUpdate  7/1/2016 12:00:00 AM4/20/2016 5:46 PM
Details340B IDUpdate ONLINE_REG_58888DSH0700254/6/2016 8:03 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/6/2016 8:00 AM
Medicaid BillingMedicaid: NumberInsert  0080572224/6/2016 8:00 AM
Medicaid BillingMedicaid: StateInsert  CT4/6/2016 8:00 AM
Details340B IDUpdate  ONLINE_REG_588884/4/2016 2:54 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/4/2016 2:54 PM
Medicaid BillingMedicaid: NumberInsert  40418694/4/2016 2:54 PM
Medicaid BillingMedicaid: StateInsert  CT4/4/2016 2:54 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/4/2016 2:54 PM
Medicaid BillingMedicaid: NumberInsert  40251514/4/2016 2:54 PM
Medicaid BillingMedicaid: StateInsert  CT4/4/2016 2:54 PM
Medicaid BillingNPI: NumberInsert  19028348804/4/2016 2:54 PM
Medicaid BillingNPI: NumberInsert  17706966434/4/2016 2:54 PM
Medicaid BillingNPI: NumberInsert  17901835154/4/2016 2:54 PM
DetailsLast Recertification DateInsert   4/4/2016 2:54 PM
DetailsGrant NumberInsert   4/4/2016 2:54 PM
Details340B IDInsert   4/4/2016 2:54 PM
DetailsIs Authorizing Official EHB DataInsert   4/4/2016 2:54 PM
DatesLast Date That 340B Drugs PurchasedInsert   4/4/2016 2:54 PM
DetailsMedicare Provider NumberInsert  0700254/4/2016 2:54 PM
DetailsEntity NameInsert  HARTFORD HOSPITAL4/4/2016 2:54 PM
DetailsProgram CodeInsert  DSH4/4/2016 2:54 PM
DetailsEntity SubnameInsert   4/4/2016 2:54 PM
DatesParticipating Approval DateInsert   4/4/2016 2:54 PM
DetailsStateInsert  Pending4/4/2016 2:54 PM
DatesRegistration DateInsert  4/4/2016 12:00:00 AM4/4/2016 2:54 PM
DatesSigned By DateInsert  4/4/2016 12:00:00 AM4/4/2016 2:54 PM
DatesStart DateInsert   4/4/2016 2:54 PM
TerminationsTermination CommentsInsert   4/4/2016 2:54 PM
TerminationsTermination DateInsert   4/4/2016 2:54 PM
TerminationsTermination Effective DateInsert   4/4/2016 2:54 PM
TerminationsTermination ReasonInsert   4/4/2016 2:54 PM