Contract Pharmacy Details

HARTFORD HOSPITAL
DSH070028 ST. VINCENTS MEDICAL CENTER

Covered Entity Details

Entity Name

ST. VINCENTS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH070028

Entity Address

2800 MAIN STREET
BRIDGEPORT, CT 06606-4201

Medicare Provider Number

070028

Participating Start Date

1/13/2023

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

HARTFORD HOSPITAL

Pharmacy Address

DBA HARTFORD HEALTHCARE RETAIL PHARMACY
85 SEYMOUR ST STE 105
HARTFORD, CT 06106

Pharmacy Comments

Contract Details

Approval Date

4/28/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Christopher Given, VP, Finance
(475) 210-6193

Contract Pharmacy Representative

Hartford HealthCare
Brianne Nichols, Pharmacy Manager
(860) 972-7096

Signed By Date

4/10/2020

340B Drug Pricing Program Database