340B Drug Pricing Program Database
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DSH070024D THE WILLIAM W. BACKUS HOSPITAL (Active)
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Main Details
Name
THE WILLIAM W. BACKUS HOSPITAL
Subdivision Name
BH Infectious Disease - Infectious Disease - Infectious Disease
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070024D
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
107 Lafayette St
Norwich, CT 06360
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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