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HARTFORD HOSPITAL
DSH070011 CHARLOTTE HUNGERFORD HOSPITAL
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Covered Entity Details
Entity Name
CHARLOTTE HUNGERFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070011
Entity Address
540 LITCHFIELD STREET
TORRINGTON, CT 06790-0988
Medicare Provider Number
070011
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HARTFORD HOSPITAL
Pharmacy Address
DBA HARTFORD HEALTHCARE RETAIL PHARMACY
85 SEYMOUR ST STE 105
HARTFORD, CT 06106
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cheryl Considine, Director Finance, NW Region
(860) 496-6740
Contract Pharmacy Representative
Hartford HealthCare
Brianne Nichols, Pharmacy Manager
(860) 972-7096
Signed By Date
1/8/2025
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