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CONNECTICUT CVS PHARMACY, L.L.C.
DSH070007 LAWRENCE & MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE & MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070007
Entity Address
365 MONTAUK AVENUE
NEW LONDON, CT 06320-4700
Medicare Provider Number
070007
Participating Start Date
7/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01268
106 BOSTON POST ROAD
WATERFORD, CT 06385
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas Payne, Director, Reimbursement Yale New Haven Health System
(203) 688-4878
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2019
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