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CVS PHARMACY INC
DSH070003 Day Kimball Hospital
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Covered Entity Details
Entity Name
Day Kimball Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070003
Entity Address
320 Pomfret Street
Putnam, CT 06260-1869
Medicare Provider Number
070003
Participating Start Date
7/1/2013
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY INC
Pharmacy Address
150 INDUSTRIAL DR., WRHS #2
NORTH SMITHFIELD, RI 02896
Pharmacy Comments
Contract Details
Approval Date
10/17/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald St. Onge, Sr. VP, COO, CNO
(860) 928-6541 Ext: 2323
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
10/17/2014
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