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CONNECTICUT CVS PHARMACY, L.L.C.
DSH070025 HARTFORD HOSPITAL
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Covered Entity Details
Entity Name
HARTFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070025
Entity Address
80 SEYMOUR STREET
HARTFORD, CT 06102
Medicare Provider Number
070025
Participating Start Date
7/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #11072
344 N MAIN ST
WEST HARTFORD, CT 06117
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gerald Boisvert, Vice President, Finance Operations
(860) 545-0585
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2019
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