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DSH070025AE HARTFORD HOSPITAL (Terminated)
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Main Details
Name
HARTFORD HOSPITAL
Subdivision Name
HH IOL SCHIZRHB MH OP 101067045 - 90.05
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070025AE
Medicare Provider Number
070025
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/21/2016
Last Recertification Date
8/30/2021
Termination Date
Termination Reason
7/1/2022
Other
Contacts
Authorizing Official
Hartford Hospital
David Fichandler, Senior Director, Clinical Operations
(860) 972-2450
Primary Contact
Hartford Hospital
Eric Arlia, Director of Pharmacy
(860) 972-4165
Addresses
Street Address
200 Retreat Street
Fuller 1
Hartford, CT 06106
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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'IF" the services (cost center code) are NOW changing as indicated "YES" by the AO-then these "NEW" services will need to registered-not submitting a change request.
04/11/2022
May 2025
May 2025
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