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CONNECTICUT CVS PHARMACY, L.L.C.
FQHCLA150 UNITED COMMUNITY & FAMILY SERVICES, INC.
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Covered Entity Details
Entity Name
UNITED COMMUNITY & FAMILY SERVICES, INC.
Subdivision Name
Type
Health Center Program Look-Alike
340B ID
FQHCLA150
Entity Address
47 TOWN STREET
NORWICH, CT 06360
Grant Number
LALCS00072
Participating Start Date
10/1/2003
Last Recertification Date
2/19/2015
Entity Termination Date
1/1/2016
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01027
372 WEST MAIN STREET
NORWICH, CT 06360
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joanne Smart, CFO
(860) 822-4153
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/16/2014
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