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YALE NEW HAVEN HEALTH HOME INFUSION
DSH070007 LAWRENCE & MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE & MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070007
Entity Address
365 MONTAUK AVENUE
NEW LONDON, CT 06320-4700
Medicare Provider Number
070007
Participating Start Date
7/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
YALE NEW HAVEN HEALTH HOME INFUSION
Pharmacy Address
600 DERBY AVE
WEST HAVEN, CT 06516
Pharmacy Comments
Contract Details
Approval Date
1/4/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leeann Miller, Chief Pharmacy Officer
(203) 479-3000
Contract Pharmacy Representative
Yale New Haven Hospital
Lorraine Lee, Executive Director, System Pharmacy Services
(203) 688-6390
Signed By Date
1/4/2023
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