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CONNECTICUT CVS PHARMACY, L.L.C.
DSH070036 UCONN HEALTH
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Covered Entity Details
Entity Name
UCONN HEALTH
Subdivision Name
JOHN DEMPSEY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH070036
Entity Address
263 FARMINGTON AVENUE
GPS/Patient way-finding: 100 Hospital Drive
FARMINGTON, CT 06032
Medicare Provider Number
070036
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01903
824 PARK AVE
BLOOMFIELD, CT 06002
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/29/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kimberly Metcalf, AVP Pharmacy and Ancillary Services
(860) 679-7943
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/12/2019
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