Covered Entity Details

RRC070034-00 NORWALK HOSPITAL (Terminated) - information as of 6/2/2025 8:32:41 AM

Main Details

Name

NORWALK HOSPITAL

Subdivision Name

Type

Rural Referral Center

Rural

Yes

340B ID

RRC070034-00

Medicare Provider Number

070034

Additional Details

Current Program Status

Terminated

Registration Date

4/1/2024

Participating Start Date

7/1/2024

Participating Approval Date

4/30/2024

Last Recertification Date

8/16/2024

Termination Date
Termination Reason

4/1/2025
DSH percentage below statutory minimum

Contacts

Authorizing Official

Nuvance Health
Karen Steele, VP Pharmacy Services
(845) 472-9571

Primary Contact

Norwalk Hospital Association
Sharlene Horner, Director of Goverment Reimbursement
(860) 307-0121

Addresses

Street Address

MAPLE ST
NORWALK, CT 06856

Billing Address

Norwalk Hospital
24 Steven St
Pharmacy 2nd floor
Norwalk, CT 06856

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participating from effective date: (10/01/2020) until terminated effective date: (04/01/2023); reinstatement effective date: (07/1/2024)	04/26/2024

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	004041943,004025235,004081593,004011219	1649263880,1427041581,1477546521,1346441953

Shipping Addresses

Shipping Address 1

Norwalk Hospital
24 Stevens St.
Norwalk, CT 06850

Shipping Address 2

Safecor
317 New Boston Street
Suite 100
Woburn, MA 01801

Shipping Address 3

Norwalk Hospital
34 Maple Street
Norwalk, CT 06856

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	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01219	229 HOPE STREET	STAMFORD	CT	06906	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00133	698 POST RD.	FAIRFIELD	CT	06824	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00854	327 MAIN AVENUE	NORWALK	CT	06851	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01149	696 WEST AVE.	NORWALK	CT	06850	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00623	397 POST ROAD EAST	WESTPORT	CT	06880	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03795	93 OLD RIDGEFIELD RD.	WILTON	CT	06897	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00918	964 POST ROAD	DARIEN	CT	06820	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01897	6 QUEEN STREET	NEWTOWN	CT	06470	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01912	1968 BLACK ROCK TURNPIKE. FAIRWAY PLAZA	FAIRFIELD	CT	06825	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01123	22 DEPOT HILL RD.	SOUTHBURY	CT	06488	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00822	40 EAST ST.	NEW MILFORD	CT	06776	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02573	1425 BARNUM AVENUE	STRATFORD	CT	06614	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01109	7 DURANT AVE.	BETHEL	CT	06801	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #5881	969 HIGH RIDGE ROAD	STAMFORD	CT	06905-1608	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02545	35 PADANARAM RD.	DANBURY	CT	06811	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01154	6 WILLARD RD.	NORWALK	CT	06851	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #7856	281 CONNECTICUT AVENUE	NORWALK	CT	06854-1938	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00738	467 MAIN ST.	RIDGEFIELD	CT	06877	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01051	593 NEWFIELD AVENUE	STAMFORD	CT	06905	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01213	94 PARK STREET	NEW CANAAN	CT	06840	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 343	66 HIGH RIDGE ROAD	STAMFORD	CT	06905	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00696	14 CANDLEWOOD LAKE RD.	BROOKFIELD	CT	06804	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10367	965 WHITE PLAINS RD.	TRUMBULL	CT	06611	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CONNECTICUT CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #10462	720 BRANCHVILLE ROAD	RIDGEFIELD	CT	06877-6129	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	04/13/2021	04/21/2021	09/02/2022	09/02/2022
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	GENOA HEALTHCARE LLC	941 BRIDGEPORT AVE	SUITE M5	MILFORD	CT	06460-3142	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	OPTUM PHARMACY 700, LLC	19 CHAPIN RD BLDG D, STE D8		PINE BROOK	NJ	07058	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	05/12/2022	05/19/2022	04/01/2023	04/01/2023
Contract Detail	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 704, INC.	5627 UNIVERSITY HTS STE 108		SAN ANTONIO	TX	78249	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/13/2021	04/21/2021	10/01/2022	10/03/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	SWC PHARMACY	24 STEVENS ST		NORWALK	CT	06850	01/14/2021	04/01/2021	04/01/2023	04/01/2023
Contract Detail	SWC PHARMACY	24 STEVENS ST		NORWALK	CT	06850	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	SWC PHARMACY CORP	120 CONNECTICUT AVE		NORWALK	CT	06854-1525	04/06/2021	04/21/2021	03/03/2022	03/03/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #21268	76 HEIGHTS RD	DARIEN	CT	06820-4128	04/13/2021	04/21/2021	04/07/2022	04/07/2022
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #11164	46-A DANBURY RD	RIDGEFIELD	CT	06877-4019	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10177	54 WEST AVE	NORWALK	CT	06854-2225	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 07145	880 POST RD E	WESTPORT	CT	06880-5223	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06308	55 WESTPORT AVE	NORWALK	CT	06851	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #10058	235 MAIN ST	NORWALK	CT	06851	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #16080	414 KINGS HWY E	FAIRFIELD	CT	06825-4846	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #09821	36 PINE ST	NEW CANAAN	CT	06840-5408	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/13/2021	04/21/2021	04/06/2022	04/06/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/13/2021	04/21/2021	04/01/2023	04/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/30/2024	07/01/2024	04/01/2025	04/01/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/30/2024	07/01/2024	04/01/2025	04/01/2025

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC070034-01	Child	RRC	NORWALK HOSPITAL	Norwalk Hospital Pediatric Development and Therapy Center - Developmental Pediatrics Rehab	761 Main Ave	Norwalk	CT	Terminated
RRC070034-02	Child	RRC	NORWALK HOSPITAL	CROSS ST RADIOLOGY - Radiology	40 CROSS ST	NORWALK	CT	Terminated
RRC070034-03	Child	RRC	NORWALK HOSPITAL	Norwalk Hospital Sleep Disorders Center - Sleep Studies	520 West Ave.	Norwalk	CT	Terminated
RRC070034-04	Child	RRC	NORWALK HOSPITAL	NORWALK RADIOLOGY AND MAMMOGRAPHY C - Radiology services	761 Main Ave	NORWALK	CT	Terminated
RRC070034-05	Child	RRC	NORWALK HOSPITAL	Westport Radiology - Radiology	333 Post Rd West	Westport	CT	Terminated
RRC070034-06	Child	RRC	NORWALK HOSPITAL	Outpatient Psychiatric Services - Intensive O/P Partial Hospital	14 Westport Ave	Norwalk	CT	Terminated
RRC070034-07	Child	RRC	NORWALK HOSPITAL	Outpatient Psychiatric Services - Clinic - Psychiatric	14 Westport Ave	Norwalk	CT	Terminated
RRC070034-08	Child	RRC	NORWALK HOSPITAL	Outpatient Psychiatric Services - Child & Adolescent Serv	14 Westport Ave	Norwalk	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		2/25/2025 12:00:00 AM	2/28/2025 7:35 AM
Details	State	Update	Termination Request	Active	To Be Terminated	2/28/2025 7:35 AM
Terminations	Termination Date	Update	Termination Request		4/1/2025 12:00:00 AM	2/28/2025 7:35 AM
Terminations	Termination Effective Date	Update	Termination Request		2/26/2025 12:00:00 AM	2/28/2025 7:35 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	2/28/2025 7:35 AM
Details	Last Recertification Date	Update	Recertification		8/16/2024 9:03:26 AM	8/16/2024 9:03 AM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Addresses	Main Address	Update	Reinstatement	34 MAPLE ST NORWALK, CT 06856	MAPLE ST NORWALK, CT 06856	4/30/2024 10:24 AM
Addresses	Shipping Address	Update	Reinstatement	Norwalk Hospital 24 Stevens St. Norwalk, CT 06856	Norwalk Hospital 24 Stevens St. Norwalk, CT 06850	4/30/2024 10:24 AM
Addresses	Billing Address	Insert	Reinstatement		Norwalk Hospital 24 Steven St Pharmacy 2nd floor Norwalk, CT 06856	4/30/2024 10:24 AM
Contacts	Primary Contact	Update	Reinstatement	Shuster, Keith Director of Pharmacy Norwalk Hospital 2038522382	Horner, Sharlene Director of Goverment Reimbursement Norwalk Hospital Association 8603070121	4/30/2024 10:24 AM
Contacts	Authorizing Official	Update	Reinstatement	Cordeau, Peter R President Norwalk Hospital Norwalk Hospital 2038522330	Steele, Karen VP Pharmacy Services Nuvance Health 8454729571	4/30/2024 10:24 AM
Contacts	Signed By	Update	Reinstatement	Cordeau, Peter R President Norwalk Hospital Norwalk Hospital 2038522330	Steele, Karen VP Pharmacy Services Nuvance Health 8454729571	4/30/2024 10:24 AM
Details	Last Recertification Date	Update	Reinstatement	9/7/2022 9:17:19 PM		4/30/2024 10:24 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	2/24/2023 12:00:00 AM		4/30/2024 10:24 AM
Dates	Participating Approval Date	Update	Reinstatement	7/31/2020 9:15:30 AM	4/30/2024 10:24:22 AM	4/30/2024 10:24 AM
Details	State	Update	Reinstatement	Terminated	Approved	4/30/2024 10:24 AM
Dates	Registration Date	Update	Reinstatement	7/8/2020 4:00:23 PM	4/1/2024 3:52:46 PM	4/30/2024 10:24 AM
Dates	Signed By Date	Update	Reinstatement	7/15/2020 12:29:34 PM	4/25/2024 1:37:21 PM	4/30/2024 10:24 AM
Dates	Start Date	Update	Reinstatement	10/1/2020 12:00:00 AM	7/1/2024 12:00:00 AM	4/30/2024 10:24 AM
Terminations	Termination Comments	Update	Reinstatement	suspended TPA splitter on 2/24/23 (pending DSH validation) and CPS suspended on 2/24/23 (confirmation took additional few days). MCR filed on 2/28/23		4/30/2024 10:24 AM
Terminations	Termination Date	Update	Reinstatement	4/1/2023 12:00:00 AM		4/30/2024 10:24 AM
Terminations	Termination Effective Date	Update	Reinstatement	2/28/2023 12:00:00 AM		4/30/2024 10:24 AM
Terminations	Termination Reason	Update	Reinstatement	DSH percentage below statutory minimum		4/30/2024 10:24 AM
Details	Comments Public	Insert	Reinstatement		Participating from effective date: (10/01/2020) until terminated effective date: (04/01/2023); reinstatement effective date: (07/1/2024)	4/26/2024 5:35 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		2/24/2023 12:00:00 AM	3/7/2023 2:51 PM
Details	State	Update	Termination Request	Active	To Be Terminated	3/7/2023 2:51 PM
Terminations	Termination Comments	Update	Termination Request		suspended TPA splitter on 2/24/23 (pending DSH validation) and CPS suspended on 2/24/23 (confirmation took additional few days). MCR filed on 2/28/23	3/7/2023 2:51 PM
Terminations	Termination Date	Update	Termination Request		4/1/2023 12:00:00 AM	3/7/2023 2:51 PM
Terminations	Termination Effective Date	Update	Termination Request		2/28/2023 12:00:00 AM	3/7/2023 2:51 PM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	3/7/2023 2:51 PM
Addresses	Billing Address	Insert	Change Request		Norwalk Hospital 24 Steven St Pharmacy 2nd floor Norwalk, CT 06856	9/14/2022 6:29 AM
Details	Last Recertification Date	Update	Recertification	8/20/2021 9:14:09 AM	9/7/2022 9:17:19 PM	9/7/2022 9:17 PM
Contacts	Primary Contact	Update	Profile Change Request	Shuster, Keith Manager Norwalk Hospital 2038522382	Shuster, Keith Director of Pharmacy Norwalk Hospital 2038522382	8/16/2022 1:11 PM
Addresses	Main Address	Update	Change Request	MAPLE ST NORWALK, CT 06856	34 MAPLE ST NORWALK, CT 06856	10/4/2021 9:47 AM
Medicaid Billing	NPI: State	Update	Recertification		CT	8/20/2021 9:14 AM
Medicaid Billing	NPI: State	Update	Recertification		CT	8/20/2021 9:14 AM
Medicaid Billing	NPI: State	Update	Recertification		CT	8/20/2021 9:14 AM
Medicaid Billing	NPI: State	Update	Recertification		CT	8/20/2021 9:14 AM
Details	Last Recertification Date	Update	Recertification		8/20/2021 9:14:09 AM	8/20/2021 9:14 AM
Addresses	Shipping Address	Insert	Change Request		Safecor 317 New Boston Street Suite 100 Woburn, MA 01801	11/18/2020 8:35 AM
Addresses	Shipping Address	Insert	Change Request		Norwalk Hospital 34 Maple Street Norwalk, CT 06856	11/18/2020 8:35 AM
Contacts	Primary Contact	Update	Change Request	Horner, Sharlene Government Reimbursement Manager Norwalk Hospital Association 8603070121	Shuster, Keith Manager Norwalk Hospital 2038522382	11/18/2020 8:35 AM
Details	State	Update		Approved	Active	10/1/2020 12:01 AM
Contacts	Signed By	Insert	New Registration		Cordeau, Peter R President Norwalk Hospital Norwalk Hospital 2038522330	7/31/2020 9:15 AM
Details	340B ID	Update	New Registration		RRC070034-00	7/31/2020 9:15 AM
Dates	Participating Approval Date	Update	New Registration		7/31/2020 9:15:30 AM	7/31/2020 9:15 AM
Details	State	Update	New Registration	Pending	Approved	7/31/2020 9:15 AM
Dates	Signed By Date	Update	New Registration		7/15/2020 12:29:34 PM	7/31/2020 9:15 AM
Dates	Start Date	Update	New Registration		10/1/2020 12:00:00 AM	7/31/2020 9:15 AM
Addresses	Main Address	Insert	New Registration		MAPLE ST NORWALK, CT 06856	7/8/2020 4:00 PM
Addresses	Shipping Address	Insert	New Registration		Norwalk Hospital 24 Stevens St. Norwalk, CT 06856	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004041943	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004025235	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004081593	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		004011219	7/8/2020 4:00 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CT	7/8/2020 4:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1649263880	7/8/2020 4:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427041581	7/8/2020 4:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1477546521	7/8/2020 4:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346441953	7/8/2020 4:00 PM
Contacts	Primary Contact	Insert	New Registration		Horner, Sharlene Government Reimbursement Manager Norwalk Hospital Association 8603070121	7/8/2020 4:00 PM
Contacts	Authorizing Official	Insert	New Registration		Cordeau, Peter R President Norwalk Hospital Norwalk Hospital 2038522330	7/8/2020 4:00 PM
Details	Last Recertification Date	Insert	New Registration			7/8/2020 4:00 PM
Details	Grant Number	Insert	New Registration			7/8/2020 4:00 PM
Details	340B ID	Insert	New Registration			7/8/2020 4:00 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/8/2020 4:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/8/2020 4:00 PM
Details	Medicare Provider Number	Insert	New Registration		070034	7/8/2020 4:00 PM
Details	Entity Name	Insert	New Registration		NORWALK HOSPITAL	7/8/2020 4:00 PM
Details	Program Code	Insert	New Registration		RRC	7/8/2020 4:00 PM
Details	Entity Subname	Insert	New Registration			7/8/2020 4:00 PM
Dates	Participating Approval Date	Insert	New Registration			7/8/2020 4:00 PM
Details	State	Insert	New Registration		Pending	7/8/2020 4:00 PM
Dates	Registration Date	Insert	New Registration		7/8/2020 4:00:23 PM	7/8/2020 4:00 PM
Dates	Signed By Date	Insert	New Registration			7/8/2020 4:00 PM
Dates	Start Date	Insert	New Registration			7/8/2020 4:00 PM
Terminations	Termination Comments	Insert	New Registration			7/8/2020 4:00 PM
Terminations	Termination Date	Insert	New Registration			7/8/2020 4:00 PM
Terminations	Termination Effective Date	Insert	New Registration			7/8/2020 4:00 PM
Terminations	Termination Reason	Insert	New Registration			7/8/2020 4:00 PM