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BRISTOL HEALTH PHARMACY, LLC
DSH070029 BRISTOL HOSPITAL INC
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Covered Entity Details
Entity Name
BRISTOL HOSPITAL INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070029
Entity Address
41 BREWSTER ROAD
BRISTOL, CT 06010
Medicare Provider Number
070029
Participating Start Date
10/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
BRISTOL HEALTH PHARMACY, LLC
Pharmacy Address
BRISTOL HOSPITAL
41 BREWSTER RD
BRISTOL, CT 06010
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kurt Barwis, President
(860) 585-3222
Contract Pharmacy Representative
Bristol Hospital
Veda Bak, Manager of Reimbursement
(860) 585-3814
Signed By Date
4/13/2021
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