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STOP AND SHOP PHARMACY #2613
DSH070002 Saint Francis Hospital and Medical Center
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Covered Entity Details
Entity Name
Saint Francis Hospital and Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070002
Entity Address
114 Woodland Street
Hartford, CT 06105
Medicare Provider Number
070002
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
STOP AND SHOP PHARMACY #2613
Pharmacy Address
206 KITTS LANE
NEWINGTON, CT 06111
Pharmacy Comments
Contract Details
Approval Date
1/12/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer S Schneider, SVP and Chief Financial Officer
(860) 714-5360
Contract Pharmacy Representative
Stop and Shop
David Dunn, Pharmacy Operations Manager
(774) 644-1263
Signed By Date
1/12/2023
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