Contract Pharmacy Details

CONNECTICUT CVS PHARMACY, L.L.C.
DSH070028 ST. VINCENTS MEDICAL CENTER

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

CONNECTICUT CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 17072
120 HAWLEY LN
TRUMBULL, CT 06611

Pharmacy Comments

Contract Details

Approval Date

1/13/2023

Contract Begin Date

1/13/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Christopher Given, VP, Finance
(475) 210-6193

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/8/2023

340B Drug Pricing Program Database