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OPTUM PHARMACY 704, INC.
DSH070035 The Hospital of Central Connecticut
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Covered Entity Details
Entity Name
The Hospital of Central Connecticut
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070035
Entity Address
100 Grand St.
New Britain, CT 06052
Medicare Provider Number
070035
Participating Start Date
7/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 704, INC.
Pharmacy Address
5627 UNIVERSITY HTS STE 108
SAN ANTONIO, TX 78249
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sean Michael Curtin, Vice President, Finance, Hartford Region
(860) 545-0585
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/15/2021
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