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NELSON'S PHARMACY INC
CH01241E STAYWELL HEALTH CARE, INC.
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Covered Entity Details
Entity Name
STAYWELL HEALTH CARE, INC.
Subdivision Name
StayWell Health Center
Type
HRSA-Funded Health Center
340B ID
CH01241E
Entity Address
402 E MAIN ST
WATERBURY, CT 06702-1701
Grant Number
H80CS00350
Participating Start Date
4/1/2015
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
NELSON'S PHARMACY INC
Pharmacy Address
153 MAPLE ST
NAUGATUCK, CT 06770
Pharmacy Comments
Contract Details
Approval Date
3/12/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2015
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Giriaco Russo, RPh, Pres
(203) 729-2297
Signed By Date
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