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WAL-MART PHARMACY 10-5439
DSH070022 YALE NEW HAVEN HOSPITAL
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Covered Entity Details
Entity Name
YALE NEW HAVEN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070022
Entity Address
20 York Street
New Haven, CT 06510
Medicare Provider Number
070022
Participating Start Date
7/1/2004
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5439
Pharmacy Address
315 FOXON BLVD
NEW HAVEN, CT 06513
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
10/20/2024
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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