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BELLA VISTA PHARMACY
CH01006C FAIR HAVEN COMMUNITY HEALTH CLINIC INC
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Covered Entity Details
Entity Name
FAIR HAVEN COMMUNITY HEALTH CLINIC INC
Subdivision Name
FAIR HAVEN MEDICAL GROUP - BELLA VISTA
Type
HRSA-Funded Health Center
340B ID
CH01006C
Entity Address
339 Eastern St
New Haven, CT 06513-2463
Grant Number
H80CS00741
Participating Start Date
10/1/2010
Last Recertification Date
2/15/2025
Pharmacy Details
Pharmacy Name
BELLA VISTA PHARMACY
Pharmacy Address
321 EASTERN ST BLDG A
NEW HAVEN, CT 06513
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
10/25/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
10/13/2010
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