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CONNECTICUT CVS PHARMACY, L.L.C.
PED073300-00 CONNECTICUT CHILDREN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Subdivision Name
Type
Children's Hospital
340B ID
PED073300-00
Entity Address
282 WASHINGTON STREET
HARTFORD, CT 06106
Medicare Provider Number
073300
Participating Start Date
7/1/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00231
142 TALCOTTVILLE ROAD
VERNON, CT 06066
Pharmacy Comments
Contract Details
Approval Date
10/7/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert Elijah Duncan, Executive Vice President & Chief Operating Officer
(860) 545-8648
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/7/2022
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