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CONNECTICUT CVS PHARMACY, L.L.C.
DSH070010 BRIDGEPORT HOSPITAL
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Covered Entity Details
Entity Name
BRIDGEPORT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070010
Entity Address
267 GRANT STREET
BRIDGEPORT, CT 06610-0120
Medicare Provider Number
070010
Participating Start Date
4/1/2006
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02259
215 WHALLEY AVENUE
NEW HAVEN, CT 06511
Pharmacy Comments
Contract Details
Approval Date
4/9/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/18/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary G Messina, Director, Regulatory Reimbursement YNHHS
(203) 688-8543
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
4/9/2021
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