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RRC070031-00 THE GRIFFIN HOSPITAL (Terminated)
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Main Details
Name
THE GRIFFIN HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC070031-00
Medicare Provider Number
070031
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/25/2022
Last Recertification Date
9/18/2023
Termination Date
Termination Reason
7/1/2024
Change of covered entity type
Contacts
Authorizing Official
Griffin Hospital
Alexander Stephen Balko, VP Finance/CFO
(203) 732-7594
Primary Contact
Griffin Hospital
Lisa Jean Jaser, Director of Pharmacy
(203) 732-7311
Addresses
Street Address
130 DIVISION STREET
DERBY, CT 06418
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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