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CONNECTICUT CVS PHARMACY, L.L.C.
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
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00145
330 MAIN STREET
FARMINGTON, CT 06032
Pharmacy Comments
Contract Details
Approval Date
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey P. Geoghegan, CFO
(860) 679-3162
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
1/15/2016
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