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CONNECTICUT CVS PHARMACY, L.L.C.
CH01241D STAYWELL HEALTH CARE, INC.
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Covered Entity Details
Entity Name
STAYWELL HEALTH CARE, INC.
Subdivision Name
StayWell South End Health Center II
Type
HRSA-Funded Health Center
340B ID
CH01241D
Entity Address
1309 S Main St
Waterbury, CT 06706-1758
Grant Number
H80CS00350
Participating Start Date
7/1/2013
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01139
2610 E MAIN ST.
BRIARWOODS S/C
BRIDGEPORT, CT 06610
Pharmacy Comments
Contract Details
Approval Date
4/3/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
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
4/3/2020
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