Covered Entity Details

RRC070024-04 THE WILLIAM W. BACKUS HOSPITAL (Terminated) - information as of 5/30/2025 6:46:49 PM

Main Details

Name

THE WILLIAM W. BACKUS HOSPITAL

Subdivision Name

BACKUS CENTER FOR SPECIALTY CARE - Plainfield Infusion Center

Type

Rural Referral Center

Rural

Yes

340B ID

RRC070024-04

Medicare Provider Number

070024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/5/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/27/2025

Last Recertification Date

Termination Date
Termination Reason

4/1/2025
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Hartford HealthCare
Anthony Mastroianni, Regional Vice President, Finance
(860) 889-8331 Ext: 2311

Primary Contact

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

Addresses

Street Address

584 NORWICH RD
PLAINFIELD, CT 06374-1727

Billing Address

William W. Backus Hospital
326 Washington Street
Norwich, CT 06360

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating 07/01/2019 until terminated effective 03/13/2023, reinstated 04/01/2025.	02/26/2025

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	004041851,004025144	1639135718,1730243536,1467517235

Shipping Addresses

Same as Street Address

Contract Pharmacies

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

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC070024-01	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	Backus Outpatient Care Center Rheumatology	111 Salem Turnkpike	Norwich	CT	Terminated
RRC070024-02	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	Backus Outpatient Care Center Endocrinology	111 Salem Turnkpike	Norwich	CT	Terminated
RRC070024-03	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	Plainfield ED / Emergency Department	582 Norwich Road	Plainfield	CT	Terminated
RRC070024-04	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	BACKUS CENTER FOR SPECIALTY CARE - Plainfield Infusion Center	584 NORWICH RD	PLAINFIELD	CT	Terminated
RRC070024-05	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	Hartford Healthcare Cancer Institute Backus Hospital - Waterford Infusion Center	196 PARKWAY SOUTH Suite 303	Waterford	CT	Terminated
RRC070024-06	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	Waterford Med ONC CI - Medical Oncology Group at Waterford	196 Parkway South Suite 303	Waterford	CT	Terminated
RRC070024-07	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	Backus Outpatient Care Center Nutrition - BH Diabetes and Nutrition Services	111 Salem Turnpike Suite 3	Norwich	CT	Terminated
RRC070024-08	Child	RRC	THE WILLIAM W. BACKUS HOSPITAL	BH Infectious Disease - Infectious Disease	107 Lafayette St	Norwich	CT	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/1/2025 12:00:00 AM	3/4/2025 2:04 PM
Details	State	Update	Termination Request	Approved	To Be Terminated	3/4/2025 2:04 PM
Terminations	Termination Comments	Update	Termination Request		please cancel this RRC registration, our DSH% is 11.84% on our MCR which was filed 2/28/25, allowing us to remain a DSH.	3/4/2025 2:04 PM
Terminations	Termination Date	Update	Termination Request		4/1/2025 12:00:00 AM	3/4/2025 2:04 PM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2025 12:00:00 AM	3/4/2025 2:04 PM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	3/4/2025 2:04 PM
Addresses	Billing Address	Insert	Reinstatement		William W. Backus Hospital 326 Washington Street Norwich, CT 06360	2/27/2025 7:13 AM
Contacts	Primary Contact	Update	Reinstatement	whittaker, william director of pharmacy Backus Hospital 8608856435	Sweeney, Elyse A System 340B Program Manager Hartford Healthcare 8609725030	2/27/2025 7:13 AM
Details	Last Recertification Date	Update	Reinstatement	8/30/2022 8:33:26 AM		2/27/2025 7:13 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	3/13/2023 12:00:00 AM		2/27/2025 7:13 AM
Dates	Participating Approval Date	Update	Reinstatement	6/3/2019 7:01:59 AM	2/27/2025 7:13:33 AM	2/27/2025 7:13 AM
Details	State	Update	Reinstatement	Terminated	Approved	2/27/2025 7:13 AM
Dates	Registration Date	Update	Reinstatement	4/4/2019 10:34:00 AM	1/5/2025 11:15:06 AM	2/27/2025 7:13 AM
Dates	Signed By Date	Update	Reinstatement	4/4/2019 1:31:12 PM	1/6/2025 11:08:09 AM	2/27/2025 7:13 AM
Dates	Start Date	Update	Reinstatement	7/1/2019 12:00:00 AM	4/1/2025 12:00:00 AM	2/27/2025 7:13 AM
Terminations	Termination Comments	Update	Reinstatement	Immediate start date request from RRC to DSH approved 03-13-23		2/27/2025 7:13 AM
Terminations	Termination Date	Update	Reinstatement	3/13/2023 12:00:00 AM		2/27/2025 7:13 AM
Terminations	Termination Effective Date	Update	Reinstatement	3/13/2023 12:00:00 AM		2/27/2025 7:13 AM
Terminations	Termination Reason	Update	Reinstatement	Change of hospital entity type		2/27/2025 7:13 AM
Details	Comments Public	Insert	Reinstatement		Participating 07/01/2019 until terminated effective 03/13/2023, reinstated 04/01/2025.	2/26/2025 3:26 PM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	4/1/2023 12:00:00 AM	3/13/2023 12:00:00 AM	3/13/2023 8:01 AM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	3/13/2023 8:01 AM
Terminations	Termination Comments	Update	OPA Edit Termination Info		Immediate start date request from RRC to DSH approved 03-13-23	3/13/2023 8:01 AM
Terminations	Termination Date	Update	OPA Edit Termination Info	4/1/2023 12:00:00 AM	3/13/2023 12:00:00 AM	3/13/2023 8:01 AM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	4/1/2023 12:00:00 AM	3/13/2023 12:00:00 AM	3/13/2023 8:01 AM
Terminations	Termination Reason	Update	OPA Edit Termination Info	Change of covered entity type	Change of hospital entity type	3/13/2023 8:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		4/1/2023 12:00:00 AM	3/13/2023 7:52 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	3/13/2023 7:52 AM
Terminations	Termination Date	Update	Hospital Type Change Request		4/1/2023 12:00:00 AM	3/13/2023 7:52 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		4/1/2023 12:00:00 AM	3/13/2023 7:52 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	3/13/2023 7:52 AM
Contacts	Primary Contact	Update	PC Change Request	Tessier, Nicholas Director of Pharmacy Backus and WIndham Hospitals 8608856435	whittaker, william director of pharmacy Backus Hospital 8608856435	8/31/2022 12:00 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 8:53:35 AM	8/30/2022 8:33:26 AM	8/30/2022 8:33 AM
Details	Last Recertification Date	Update	Recertification	8/19/2020 8:30:55 AM	8/17/2021 8:53:35 AM	8/17/2021 8:53 AM
Medicaid Billing	NPI: State	Update	Recertification		CT	8/19/2020 8:30 AM
Medicaid Billing	NPI: State	Update	Recertification		CT	8/19/2020 8:30 AM
Medicaid Billing	NPI: State	Update	Recertification		CT	8/19/2020 8:30 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 9:32:07 AM	8/19/2020 8:30:55 AM	8/19/2020 8:30 AM
Details	Last Recertification Date	Update	Recertification		8/20/2019 9:32:07 AM	8/20/2019 9:32 AM
Details	State	Update		Approved	Active	7/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Mastroianni, Anthony Regional Vice President, Finance Hartford HealthCare 8608898331-2311	6/3/2019 7:01 AM
Details	340B ID	Update	New Registration		RRC070024-04	6/3/2019 7:01 AM
Details	Entity Subname	Update	New Registration	BACKUS CENTER FOR SPECIALTY CARE	BACKUS CENTER FOR SPECIALTY CARE - Plainfield Infusion Center	6/3/2019 7:01 AM
Dates	Participating Approval Date	Update	New Registration		6/3/2019 7:01:59 AM	6/3/2019 7:01 AM
Details	State	Update	New Registration	Pending	Approved	6/3/2019 7:01 AM
Dates	Signed By Date	Update	New Registration		4/4/2019 1:31:12 PM	6/3/2019 7:01 AM
Dates	Start Date	Update	New Registration		7/1/2019 12:00:00 AM	6/3/2019 7:01 AM
Addresses	Main Address	Insert	New Registration		584 NORWICH RD PLAINFIELD, CT 06374-1727	4/4/2019 10:34 AM
Addresses	Billing Address	Insert	New Registration		William W. Backus Hospital 326 Washington Street Norwich, CT 06360	4/4/2019 10:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2019 10:34 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004041851	4/4/2019 10:34 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	4/4/2019 10:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2019 10:34 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004025144	4/4/2019 10:34 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	4/4/2019 10:34 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1639135718	4/4/2019 10:34 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1730243536	4/4/2019 10:34 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1467517235	4/4/2019 10:34 AM
Contacts	Authorizing Official	Insert	New Registration		Mastroianni, Anthony Regional Vice President, Finance Hartford HealthCare 8608898331-2311	4/4/2019 10:34 AM
Contacts	Primary Contact	Insert	New Registration		Tessier, Nicholas Director of Pharmacy Backus and WIndham Hospitals 8608856435	4/4/2019 10:34 AM
Details	Last Recertification Date	Insert	New Registration			4/4/2019 10:34 AM
Details	Grant Number	Insert	New Registration			4/4/2019 10:34 AM
Details	340B ID	Insert	New Registration			4/4/2019 10:34 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2019 10:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2019 10:34 AM
Details	Medicare Provider Number	Insert	New Registration		070024	4/4/2019 10:34 AM
Details	Entity Name	Insert	New Registration		THE WILLIAM W. BACKUS HOSPITAL	4/4/2019 10:34 AM
Details	Program Code	Insert	New Registration		RRC	4/4/2019 10:34 AM
Details	Entity Subname	Insert	New Registration		BACKUS CENTER FOR SPECIALTY CARE	4/4/2019 10:34 AM
Dates	Participating Approval Date	Insert	New Registration			4/4/2019 10:34 AM
Details	State	Insert	New Registration		Pending	4/4/2019 10:34 AM
Dates	Registration Date	Insert	New Registration		4/4/2019 10:34:00 AM	4/4/2019 10:34 AM
Dates	Signed By Date	Insert	New Registration			4/4/2019 10:34 AM
Dates	Start Date	Insert	New Registration			4/4/2019 10:34 AM
Terminations	Termination Comments	Insert	New Registration			4/4/2019 10:34 AM
Terminations	Termination Date	Insert	New Registration			4/4/2019 10:34 AM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2019 10:34 AM
Terminations	Termination Reason	Insert	New Registration			4/4/2019 10:34 AM