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UMASS MEMORIAL MEDICAL CENTER, INC.
DSH070025 HARTFORD HOSPITAL
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Covered Entity Details
Entity Name
HARTFORD HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH070025
Entity Address
80 SEYMOUR STREET
HARTFORD, CT 06102
Medicare Provider Number
070025
Participating Start Date
7/1/2016
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
UMASS MEMORIAL MEDICAL CENTER, INC.
Pharmacy Address
UMASS MEMORIAL MEDICAL CENTER SPECIALTY
55 LAKE AVE N
ACC BUILDING - 1ST FLOOR - SUITE AC1.033
WORCESTER, MA 01655-0002
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gerald Boisvert, Vice President, Finance Operations
(860) 545-0585
Contract Pharmacy Representative
UMass Memorial Medical Center
Alice Shakman, Vice President Operations
(774) 443-0540
Signed By Date
7/15/2016
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