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CONNECTICUT CVS PHARMACY, L.L.C.
DSH070006 THE STAMFORD HOSPITAL
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Covered Entity Details
Entity Name
THE STAMFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070006
Entity Address
One Hospital Plaza
STAMFORD, CT 06902
Medicare Provider Number
070006
Participating Start Date
7/1/2016
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY # 343
66 HIGH RIDGE ROAD
STAMFORD, CT 06905
Pharmacy Comments
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ellen Komar, CNO & Sr VP -Patient Services
(203) 276-7401 Ext: 7401
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2018
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