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YALE NEW HAVEN HEALTH PHARMACY BRIDGEPOR
DSH070007 LAWRENCE & MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE & MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070007
Entity Address
365 MONTAUK AVENUE
NEW LONDON, CT 06320-4700
Medicare Provider Number
070007
Participating Start Date
7/1/2019
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
YALE NEW HAVEN HEALTH PHARMACY BRIDGEPOR
Pharmacy Address
267 GRANT ST
BRIDGEPORT, CT 06610
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leeann Miller, Chief Pharmacy Officer
(203) 479-3000
Contract Pharmacy Representative
YNHHS
Vinay Sawant, Director Specialty Pharmacy Services
(203) 747-7899
Signed By Date
10/11/2024
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