Contract Pharmacy Details

MAXI DRUG, INC.
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

MAXI DRUG, INC.

Pharmacy Address

RITE AID #10386
1619 POST ROAD
FAIRFIELD, CT 06824

Pharmacy Comments

Contract Details

Approval Date

1/17/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652

Signed By Date

1/17/2023

340B Drug Pricing Program Database