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OPTUM PHARMACY 701, LLC
DSH070035 The Hospital of Central Connecticut
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Covered Entity Details
Entity Name
The Hospital of Central Connecticut
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070035
Entity Address
100 Grand St.
New Britain, CT 06052
Medicare Provider Number
070035
Participating Start Date
7/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
OPTUM PHARMACY 701, LLC
Pharmacy Address
1830 S HORNE
MESA, AZ 85204
Pharmacy Comments
Contract Details
Approval Date
1/17/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Del Mastro, HHC Reg VP Finance Central
(959) 236-3295
Contract Pharmacy Representative
Optum
Avani Patel, VP, 340B Operations
(763) 330-5555
Signed By Date
1/17/2025
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