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CONNECTICUT CVS PHARMACY, L.L.C.
CH01241F STAYWELL HEALTH CARE, INC.
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Covered Entity Details
Entity Name
STAYWELL HEALTH CARE, INC.
Subdivision Name
Wallace School Based Health Center
Type
HRSA-Funded Health Center
340B ID
CH01241F
Entity Address
3465 E Main St
Waterbury, CT 06705-3815
Grant Number
H80CS00350
Participating Start Date
4/1/2015
Last Recertification Date
2/16/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00718
24 PERSHING DR # 36
ANSONIA, CT 06401-2214
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Donald Thompson, CEO
(203) 756-8021 Ext: 3016
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
1/14/2020
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