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WATERBURY PHARMACY
CH01241A STAYWELL HEALTH CARE, INC.
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Covered Entity Details
Entity Name
STAYWELL HEALTH CARE, INC.
Subdivision Name
DRIGGS SCHOOL BASED HLTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH01241A
Entity Address
77 Woodlawn Ter
Waterbury, CT 06710-1721
Grant Number
H80CS00350
Participating Start Date
1/1/2004
Last Recertification Date
2/16/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
WATERBURY PHARMACY
Pharmacy Address
187 E MAIN ST
WATERBURY, CT 06702
Pharmacy Comments
Contract Details
Approval Date
11/28/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Donald Thompson, CEO
(203) 756-8021 Ext: 3016
Contract Pharmacy Representative
Hartford Pharmacy
Pravin Dhulipalla, Owner
(860) 289-0000
Signed By Date
10/11/2012
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