Covered Entity Details

DSH070035S The Hospital of Central Connecticut (Active) - information as of 6/16/2025 11:20:25 PM

Main Details

Name

The Hospital of Central Connecticut

Subdivision Name

Bradley Memorial Campus - Outpatient Dept

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH070035S

Medicare Provider Number

070035

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/12/2018

Participating Start Date

4/1/2018

Participating Approval Date

1/25/2018

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

81 Meriden Avenue
C316
Southington, CT 06489

Billing Address

Hospital of Central Connecticut
P.O. Box 5037
Accounts Payable
Hartford, CT 06102

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	1053477075,1992867006,1508928615,1548225360

Shipping Addresses

Shipping Address 1

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

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
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
Addresses	Main Address	Update	Change Request	81 Meriden Avenue Southington, CT 06489	81 Meriden Avenue C316 Southington, CT 06489	12/5/2024 7:36 AM
Details	Entity Subname	Update	Change Request	Bradley Memorial Campus - Endoscopy & Outpatient Dept	Bradley Memorial Campus - Outpatient Dept	12/5/2024 7:36 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1548225360	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 8:41:26 AM	8/27/2024 8:06:40 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 3:51:46 PM	8/28/2023 8:41:26 AM	8/28/2023 8:41 AM
Details	Last Recertification Date	Update	Recertification	9/6/2021 9:37:01 AM	8/26/2022 3:51:46 PM	8/26/2022 3:51 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1548225360 (CT)		9/6/2021 9:37 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1508928615	9/6/2021 9:37 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/6/2021 9:37 AM
Details	Last Recertification Date	Update	Recertification	9/9/2020 9:13:00 PM	9/6/2021 9:37:01 AM	9/6/2021 9:37 AM
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 12:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/9/2020 9:13 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		004041950	9/9/2020 9:13 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/9/2020 9:13 PM
Medicaid Billing	NPI: State	Update	Recertification		CT	9/9/2020 9:13 PM
Medicaid Billing	NPI: State	Update	Recertification		CT	9/9/2020 9:13 PM
Medicaid Billing	NPI: State	Update	Recertification		CT	9/9/2020 9:13 PM
Details	Last Recertification Date	Update	Recertification	9/12/2019 6:46:40 AM	9/9/2020 9:13:00 PM	9/9/2020 9:13 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1992867006	3/29/2020 10:41 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1548225360	1/6/2020 7:00 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1053477075	10/10/2019 2:01 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1548225360 ( )		10/10/2019 2:01 PM
Details	Last Recertification Date	Update	Recertification	9/7/2018 9:22:45 AM	9/12/2019 6:46:40 AM	9/12/2019 6:46 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	Medicaid: Is Primary	Insert	Recertification		False	9/7/2018 9:22 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		004025243	9/7/2018 9:22 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	9/7/2018 9:22 AM
Details	Last Recertification Date	Update	Recertification		9/7/2018 9:22:45 AM	9/7/2018 9:22 AM
Addresses	Shipping Address	Delete	Change Request	Hoapital of Central Connecticut Cancer Institute Pharmacy 183 North Mountain Road BMC New Britain, CT 06053		4/10/2018 8:50 AM
Addresses	Shipping Address	Insert	Change Request		The Hospital of Central Connecticut 100 Grand Street New Britain, CT 06052	4/10/2018 8:50 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 10:54 AM
Details	State	Update		Approved	Active	4/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Edwards, Janette Vice President Operations, Central Region Hartford HealthCare 8602245421	1/25/2018 7:28 AM
Details	340B ID	Update	New Registration		DSH070035S	1/25/2018 7:28 AM
Details	Entity Subname	Update	New Registration	Bradley Memorial Campus	Bradley Memorial Campus - Endoscopy & Outpatient Dept	1/25/2018 7:28 AM
Dates	Participating Approval Date	Update	New Registration		1/25/2018 7:28:35 AM	1/25/2018 7:28 AM
Details	State	Update	New Registration	Pending	Approved	1/25/2018 7:28 AM
Dates	Signed By Date	Update	New Registration		1/15/2018 11:07:42 AM	1/25/2018 7:28 AM
Dates	Start Date	Update	New Registration		4/1/2018 12:00:00 AM	1/25/2018 7:28 AM
Addresses	Main Address	Insert	New Registration		81 Meriden Avenue Southington, CT 06489	1/12/2018 12:45 PM
Addresses	Billing Address	Insert	New Registration		Hospital of Central Connecticut P.O. Box 5037 Accounts Payable Hartford, CT 06102	1/12/2018 12:45 PM
Addresses	Shipping Address	Insert	New Registration		Hoapital of Central Connecticut Cancer Institute Pharmacy 183 North Mountain Road BMC New Britain, CT 06053	1/12/2018 12:45 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548225360	1/12/2018 12:45 PM
Contacts	Authorizing Official	Insert	New Registration		Edwards, Janette Vice President Operations, Central Region Hartford HealthCare 8602245421	1/12/2018 12:45 PM
Contacts	Primary Contact	Insert	New Registration		Girouard, David Director of Pharmacy Hospital of Central Connecticut 8602245421	1/12/2018 12:45 PM
Details	Last Recertification Date	Insert	New Registration			1/12/2018 12:45 PM
Details	Grant Number	Insert	New Registration			1/12/2018 12:45 PM
Details	340B ID	Insert	New Registration			1/12/2018 12:45 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2018 12:45 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2018 12:45 PM
Details	Medicare Provider Number	Insert	New Registration		070035	1/12/2018 12:45 PM
Details	Entity Name	Insert	New Registration		The Hospital of Central Connecticut	1/12/2018 12:45 PM
Details	Program Code	Insert	New Registration		DSH	1/12/2018 12:45 PM
Details	Entity Subname	Insert	New Registration		Bradley Memorial Campus	1/12/2018 12:45 PM
Dates	Participating Approval Date	Insert	New Registration			1/12/2018 12:45 PM
Details	State	Insert	New Registration		Pending	1/12/2018 12:45 PM
Dates	Registration Date	Insert	New Registration		1/12/2018 12:45:21 PM	1/12/2018 12:45 PM
Dates	Signed By Date	Insert	New Registration			1/12/2018 12:45 PM
Dates	Start Date	Insert	New Registration			1/12/2018 12:45 PM
Terminations	Termination Comments	Insert	New Registration			1/12/2018 12:45 PM
Terminations	Termination Date	Insert	New Registration			1/12/2018 12:45 PM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2018 12:45 PM
Terminations	Termination Reason	Insert	New Registration			1/12/2018 12:45 PM