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WAL-MART PHARMACY 10-1980
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
WAL-MART PHARMACY 10-1980
Pharmacy Address
625 SCHOOL ST
PUTNAM, CT 06260
Pharmacy Comments
Contract Details
Approval Date
10/14/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul A. Beaudoin, Chief Financial Officer
(860) 928-6541 Ext: 2113
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
10/14/2016
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