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RITE AID OF CONNECTICUT, INC.
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
RITE AID OF CONNECTICUT, INC.
Pharmacy Address
RITE AID #3619
1060 EAST MAIN STREET
BRIDGEPORT, CT 06608
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
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