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DSH070024K THE WILLIAM W. BACKUS HOSPITAL (Approved)
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Main Details
Name
THE WILLIAM W. BACKUS HOSPITAL
Subdivision Name
Backus MED ONC CI- Willimantic - Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070024K
Medicare Provider Number
070024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/1/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/3/2025
Last Recertification Date
Contacts
Authorizing Official
Hartford HealthCare
Anthony Mastroianni, Regional Vice President, Finance
(860) 889-8331 Ext: 2311
Primary Contact
Hartford HealthCare
Elyse Anna Lanteigne, 340B Program Manager
(860) 972-5030
Addresses
Street Address
5 Founders Street
Suite 200
Willimantic, CT 06226
Billing Address
The William W. Backus Hospital
PO BOX 5037
Attn: Accounts Payable
Hartford, CT 06102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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