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WALGREEN EASTERN CO., INC.
RWI06030 University of Connecticut Health Center
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Covered Entity Details
Entity Name
University of Connecticut Health Center
Subdivision Name
Division of Infectious Diseases / Infectious Diseases Clinic
Type
Ryan White Part A
340B ID
RWI06030
Entity Address
263 Farmington Avenue
Farmington, CT 06030-3212
Grant Number
H89HA00044
Participating Start Date
1/1/2012
Last Recertification Date
3/2/2025
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS #15207
668 FARMINGTON AVE
WEST HARTFORD, CT 06119
Pharmacy Comments
Contract Details
Approval Date
1/4/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin D. Dieckhaus, Chief, Division of Infectious Diseases
(860) 679-4700
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/4/2017
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