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CONNECTICUT CVS PHARMACY, L.L.C.
RRC070017-00 MIDSTATE MEDICAL CENTER
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Covered Entity Details
Entity Name
MIDSTATE MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070017-00
Entity Address
435 LEWIS AVENUE
MERIDEN, CT 06451
Medicare Provider Number
070017
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06807
153 BROAD STREET
MERIDEN, CT 06450
Pharmacy Comments
Contract Details
Approval Date
10/20/2022
Contract Begin Date
10/20/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sean Michael Curtin, Vice President, Finance, Hartford Region
(860) 545-0585
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2022
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