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DELLA PIETRA PHARMACY
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
DELLA PIETRA PHARMACY
Pharmacy Address
792 HIGHLAND AVE
WATERBURY, CT 06708
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
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
Della Pietra Pharmacy
JOSEPH LIVOLSI, MANAGER
(203) 754-0181
Signed By Date
4/15/2019
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