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DSH070025V HARTFORD HOSPITAL (Terminated)
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Main Details
Name
HARTFORD HOSPITAL
Subdivision Name
Avon Cancer Center Medical Physics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070025V
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
9/1/2016
Termination Date
Termination Reason
1/1/2017
Loss of qualifying grant/support
Contacts
Authorizing Official
Hartford Hospital
Gerald Boisvert, Vice President, Finance Operations
(860) 545-0585
Primary Contact
Hartford Hospital
Eric Arlia, Director of Pharmacy
(860) 972-4165
Addresses
Street Address
80 Fisher Road
First Floor
Avon, CT 06001
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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