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APOTHECARY & WELLNESS CENTER
DSH220066 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220066
Entity Address
271 CAREW STREET
SPRINGFIELD, MA 01104
Medicare Provider Number
220066
Participating Start Date
7/1/2004
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
APOTHECARY & WELLNESS CENTER
Pharmacy Address
1450 CHAPEL STREET
NEW HAVEN, CT 06511-4405
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stuart Edward Rosenberg, Vice President of Operations
(413) 748-9008
Contract Pharmacy Representative
Yale New Haven Health System
Marjorie Lazarre, Director, Pharmaceutical Procurement and Business Practices
(203) 688-7105
Signed By Date
7/11/2019
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