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WAL-MART PHARMACY 10-2331
DSH070007 LAWRENCE & MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE & MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070007
Entity Address
365 MONTAUK AVENUE
NEW LONDON, CT 06320-4700
Medicare Provider Number
070007
Participating Start Date
7/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2331
Pharmacy Address
155 WATERFORD PKWY NORTH
WATERFORD, CT 06385
Pharmacy Comments
Contract Details
Approval Date
4/18/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/28/2022
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
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/18/2022
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