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THE STOP & SHOP SUPERMARKT CO
DSH070028 ST. VINCENTS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. VINCENTS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070028
Entity Address
2800 MAIN STREET
BRIDGEPORT, CT 06606-4201
Medicare Provider Number
070028
Participating Start Date
1/13/2023
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
THE STOP & SHOP SUPERMARKT CO
Pharmacy Address
DBA STOP & SHOP PHARMACY #670
4531 MAIN STREET
BRIDGEPORT, CT 06606-1846
Pharmacy Comments
Contract Details
Approval Date
1/13/2023
Contract Begin Date
1/13/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christopher Given, VP, Finance
(475) 210-6193
Contract Pharmacy Representative
Stop and Shop
David Dunn, Pharmacy Operations Manager
(774) 644-1263
Signed By Date
1/8/2023
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