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STOP AND SHOP PHARMACY #2613
DSH070036 UCONN HEALTH
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Covered Entity Details
Entity Name
UCONN HEALTH
Subdivision Name
JOHN DEMPSEY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH070036
Entity Address
263 FARMINGTON AVENUE
GPS/Patient way-finding: 100 Hospital Drive
FARMINGTON, CT 06032
Medicare Provider Number
070036
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
STOP AND SHOP PHARMACY #2613
Pharmacy Address
206 KITTS LANE
NEWINGTON, CT 06111
Pharmacy Comments
Contract Details
Approval Date
10/27/2022
Contract Begin Date
10/31/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey P. Geoghegan, CFO
(860) 679-3162
Contract Pharmacy Representative
Stop and Shop
David Dunn, Pharmacy Operations Manager
(774) 644-1263
Signed By Date
10/27/2022
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