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RITE AID OF CONNECTICUT, INC.
DSH070025 HARTFORD HOSPITAL
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Covered Entity Details
Entity Name
HARTFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070025
Entity Address
80 SEYMOUR STREET
HARTFORD, CT 06102
Medicare Provider Number
070025
Participating Start Date
7/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RITE AID OF CONNECTICUT, INC.
Pharmacy Address
RITE AID #576
605 NORTH COLONY ROAD
WALLINGFORD, CT 06492
Pharmacy Comments
Contract Details
Approval Date
1/18/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Fichandler, Senior Director, Clinical Operations
(860) 972-2450
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
1/18/2023
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