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CONNECTICUT CVS PHARMACY, L.L.C.
CH01081A Southwest Community Health Center, Inc.
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Covered Entity Details
Entity Name
Southwest Community Health Center, Inc.
Subdivision Name
SOUTHWEST COMMUNITY HLTH CTR, INC
Type
HRSA-Funded Health Center
340B ID
CH01081A
Entity Address
743 South Ave
Bridgeport, CT 06604-5810
Grant Number
H80CS00613
Participating Start Date
4/11/2019
Last Recertification Date
1/28/2020
Entity Termination Date
4/1/2020
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02573
1425 BARNUM AVENUE
STRATFORD, CT 06614
Pharmacy Comments
Contract Details
Approval Date
7/8/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas J. Krause, President/CEO
(203) 332-3504
Contract Pharmacy Representative
CVS Health
Christian Reid, Sr. Director 340B
(401) 770-2118
Signed By Date
7/8/2019
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