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WAL-MART PHARMACY 10-3548
CH01241K Staywell Health Care, Inc.
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Covered Entity Details
Entity Name
Staywell Health Care, Inc.
Subdivision Name
StayWell Health Center at Western CT Mental Health Network
Type
HRSA-Funded Health Center
340B ID
CH01241K
Entity Address
95 Thomaston Ave
Waterbury, CT 06702-1007
Grant Number
H80CS00350
Participating Start Date
1/1/2018
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-3548
Pharmacy Address
910 WOLCOTT STREET
WATERBURY, CT 06705
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Donald Thompson, CEO
(203) 756-8021 Ext: 3016
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
4/12/2019
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