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BRASS CITY PHARMACY INC
CH01241C STAYWELL HEALTH CARE, INC.
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Covered Entity Details
Entity Name
STAYWELL HEALTH CARE, INC.
Subdivision Name
STAYWELL HEALTH CARE, INC.
Type
HRSA-Funded Health Center
340B ID
CH01241C
Entity Address
80 PHOENIX AVE
WATERBURY, CT 06702-1418
Grant Number
H80CS00350
Participating Start Date
1/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
BRASS CITY PHARMACY INC
Pharmacy Address
309 E MAIN ST
WATERBURY, CT 06702
Pharmacy Comments
Contract Details
Approval Date
1/7/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/22/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald Thompson, CEO
(203) 756-8021 Ext: 3016
Contract Pharmacy Representative
RAVEENDRA BOMMU, REPRESENTATIVE
(203) 759-5000
Signed By Date
1/7/2015
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