Contract Pharmacy Details

CONNECTICUT CVS PHARMACY, L.L.C.
RRC070028-00 ST. VINCENTS MEDICAL CENTER

Covered Entity Details

Entity Name

ST. VINCENTS MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC070028-00

Entity Address

2800 MAIN STREET
BRIDGEPORT, CT 06606-4201

Medicare Provider Number

070028

Participating Start Date

10/8/2021

Last Recertification Date

9/19/2022

Entity Termination Date

1/13/2023

Pharmacy Details

Pharmacy Name

CONNECTICUT CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 17072
120 HAWLEY LN
TRUMBULL, CT 06611

Pharmacy Comments

Contract Details

Approval Date

10/7/2021

Contract Begin Date

10/8/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/13/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Christopher Given, VP, Finance
(475) 210-6193

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/1/2021

340B Drug Pricing Program Database