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TRINITY HEALTH PHARMACY SERVICES, LLC
DSH070016 Saint Mary's Hospital
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Covered Entity Details
Entity Name
Saint Mary's Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070016
Entity Address
56 Franklin Street
Waterbury, CT 06706
Medicare Provider Number
070016
Participating Start Date
4/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
TRINITY HEALTH PHARMACY SERVICES, LLC
Pharmacy Address
12279 BLUFFTON RD
FORT WAYNE, IN 46809-3208
Pharmacy Comments
Contract Details
Approval Date
1/15/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer S Schneider, SVP and Chief Financial Officer
(860) 714-5360
Contract Pharmacy Representative
TRINITY HEALTH
ZACHARY ROBERTS, DIRECTOR OF SPECIALTY PHARMACY
(734) 343-7606
Signed By Date
1/15/2022
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