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BURGDORF PHARMACY INC
DSH070002 Saint Francis Hospital and Medical Center
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Covered Entity Details
Entity Name
Saint Francis Hospital and Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070002
Entity Address
114 Woodland Street
Hartford, CT 06105
Medicare Provider Number
070002
Participating Start Date
7/1/2012
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
BURGDORF PHARMACY INC
Pharmacy Address
DBA ARROW PRESCRIPTION CTR #13
131 COVENTRY ST FL 2
HARTFORD, CT 06112-1548
Pharmacy Comments
07/12/2013 - OPA request to add DEA number.
Contract Details
Approval Date
3/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Giamalis, Chief Financial Officer
(860) 714-4812
Contract Pharmacy Representative
Angelo DeFazio, President
(860) 527-2800
Signed By Date
1/15/2013
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