340B Drug Pricing Program Database
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DSH070024C THE WILLIAM W. BACKUS HOSPITAL (Active)
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Main Details
Name
THE WILLIAM W. BACKUS HOSPITAL
Subdivision Name
Waterford Med ONC CI - Medical Oncology Group at Waterford - oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070024C
Medicare Provider Number
070024
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/9/2023
Participating Start Date
3/13/2023
Participating Approval Date
3/13/2023
Last Recertification Date
8/14/2024
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 Dayton Road
Suite 205
Waterford, CT 06385
Billing Address
William W. Backus
326 Washington Street
Norwich, CT 06360
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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