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AETNA SPECIALTY PHARMACY, LLC
DSH070035 The Hospital of Central Connecticut
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Covered Entity Details
Entity Name
The Hospital of Central Connecticut
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070035
Entity Address
100 Grand St.
New Britain, CT 06052
Medicare Provider Number
070035
Participating Start Date
7/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
AETNA SPECIALTY PHARMACY, LLC
Pharmacy Address
503 SUNPORT LN
ORLANDO, FL 32809-7874
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/18/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Janette Edwards, Vice President Operations, Central Region
(860) 224-5421
Contract Pharmacy Representative
cvs
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/15/2019
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