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NEW HAVEN PHARMACY INC
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
NEW HAVEN PHARMACY INC
Pharmacy Address
374 GRAND AVE
NEW HAVEN, CT 06513
Pharmacy Comments
Contract Details
Approval Date
7/29/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SUZANNE LAGARDE, CEO
(203) 752-5129
Contract Pharmacy Representative
West Haven Pharmacy
chandra vipparla, member
(203) 522-1893
Signed By Date
7/29/2015
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