Contract Pharmacy Details

NELSON'S PHARMACY INC
CH01241B STAYWELL HEALTH CARE, INC.

Covered Entity Details

Entity Name

STAYWELL HEALTH CARE, INC.

Subdivision Name

STAYWELL HEALTH CTR - SOUTH END

Type

HRSA-Funded Health Center

340B ID

CH01241B

Entity Address

1302 S Main St
Waterbury, CT 06706-1748

Grant Number

H80CS00350

Participating Start Date

1/1/2002

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

NELSON'S PHARMACY INC

Pharmacy Address

153 MAPLE ST
NAUGATUCK, CT 06770

Pharmacy Comments

Contract Details

Approval Date

11/28/2012

Contract Begin Date

1/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/31/2015
Ownership change

Contacts

Covered Entity Signing Official

Donald Thompson, CEO
(203) 756-8021 Ext: 3016

Contract Pharmacy Representative

Giriaco Russo, RPh, Pres
(203) 729-2297

Signed By Date

10/10/2012