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WAL-MART PHARMACY 10-5095
DSH070036 UCONN HEALTH
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Covered Entity Details
Entity Name
UCONN HEALTH
Subdivision Name
JOHN DEMPSEY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH070036
Entity Address
263 FARMINGTON AVENUE
GPS/Patient way-finding: 100 Hospital Drive
FARMINGTON, CT 06032
Medicare Provider Number
070036
Participating Start Date
4/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5095
Pharmacy Address
495 FLATBUSH AVE
HARTFORD, CT 06106
Pharmacy Comments
Contract Details
Approval Date
4/13/2023
Contract Begin Date
4/20/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/20/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeffrey P. Geoghegan, CFO
(860) 679-3162
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/13/2023
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