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RAINA RX LLC
DSH070029 BRISTOL HOSPITAL INC
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Covered Entity Details
Entity Name
BRISTOL HOSPITAL INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070029
Entity Address
41 BREWSTER ROAD
BRISTOL, CT 06010
Medicare Provider Number
070029
Participating Start Date
10/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
RAINA RX LLC
Pharmacy Address
DBA ROUTE 300 PHARMACY
1208 ROUTE 300
SUITE 103
NEWBURGH, NY 12550
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kurt Barwis, President
(860) 585-3222
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
7/14/2023
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