Contract Pharmacy Details

HARTFORD PHARMACY II
CHC29001-00 WHEELER CLINIC, INC. THE

Covered Entity Details

Entity Name

WHEELER CLINIC, INC. THE

Subdivision Name

Bristol Family Health and Wellness Center

Type

HRSA-Funded Health Center

340B ID

CHC29001-00

Entity Address

1 Hope Street
Bristol, CT 06010-8122

Grant Number

H80CS29001

Participating Start Date

1/1/2018

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

HARTFORD PHARMACY II

Pharmacy Address

57 PARK ST
HARTFORD, CT 06106

Pharmacy Comments

Contract Details

Approval Date

1/12/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/7/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Athena Marie Dellas, Chief Financial Officer
(860) 793-4235

Contract Pharmacy Representative

Hartford Pharmacy
Pravin Dhulipalla, Owner
(860) 289-0000

Signed By Date

1/12/2018

340B Drug Pricing Program Database