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HANCOCK PHARMACY VII
CH010060 FAIR HAVEN COMMUNITY HEALTH CLINIC INC
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Covered Entity Details
Entity Name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Subdivision Name
FAIR HAVEN COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH010060
Entity Address
374 Grand Ave
New Haven, CT 06513-3733
Grant Number
H80CS00741
Participating Start Date
7/1/2003
Last Recertification Date
2/15/2025
Pharmacy Details
Pharmacy Name
HANCOCK PHARMACY VII
Pharmacy Address
306 GRAND AVE
NEW HAVEN, CT 06513
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
8/11/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
RAJENDRA APPALANENI, OWNER
(203) 776-7100
Signed By Date
8/4/2010
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