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OPTION CARE ENTERPRISES, INC.
DSH070010 BRIDGEPORT HOSPITAL
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Covered Entity Details
Entity Name
BRIDGEPORT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070010
Entity Address
267 GRANT STREET
BRIDGEPORT, CT 06610-0120
Medicare Provider Number
070010
Participating Start Date
4/1/2006
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
OPTION CARE ENTERPRISES, INC.
Pharmacy Address
D/B/A OPTION CARE
80 CLARK DRIVE
UNIT 1-A
EAST BERLIN, CT 06023-1157
Pharmacy Comments
Contract Details
Approval Date
7/5/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PATRICK MCCABE, SENIOR VP FINANCE/CFO
(203) 688-2345
Contract Pharmacy Representative
Option Care
Jon Adair, Vice President, Health System Solutions
(847) 830-9996
Signed By Date
7/5/2016
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