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RRC070024-05 THE WILLIAM W. BACKUS HOSPITAL (Terminated)
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Main Details
Name
THE WILLIAM W. BACKUS HOSPITAL
Subdivision Name
Hartford Healthcare Cancer Institute Backus Hospital - Waterford Infusion Center
Type
Rural Referral Center
Rural
Yes
340B ID
RRC070024-05
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
196 PARKWAY SOUTH Suite 303
Waterford, CT 06385
Billing Address
William W. Backus Hospital
326 Washington Street
Norwich, CT 06360
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating 07/01/2019 until terminated effective 03/13/2023, reinstated 04/01/2025.
02/26/2025
June 2025
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