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RRC070017-01 MIDSTATE MEDICAL CENTER (Approved)
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Main Details
Name
MIDSTATE MEDICAL CENTER
Subdivision Name
MMC MEDIQUICK MERIDEN - urgent care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC070017-01
Medicare Provider Number
070017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/1/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/15/2025
Last Recertification Date
Contacts
Authorizing Official
Hartford Healthcare
Joseph Del Mastro, HHC Reg VP Finance Central
(959) 236-3295
Primary Contact
Hartford HealthCare
Elyse Anna Lanteigne, 340B Program Manager
(860) 972-5030
Addresses
Street Address
61 Pomeroy Avenue
Meriden, CT 06450
Billing Address
Midstate Medical Center
PO BOX 5037
Attn: accounts payable
Hartford, CT 06102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 6/5/2023, Termination 4/1/2025, Reinstatement 7/1/2025
04/02/2025
May 2025
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