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APOTHECARY & WELLNESS CENTER
RRC070007-00 Lawrence & Memorial Hospital
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Covered Entity Details
Entity Name
Lawrence & Memorial Hospital
Subdivision Name
Type
Rural Referral Center
340B ID
RRC070007-00
Entity Address
365 Montauk Ave
New London, CT 06320
Medicare Provider Number
070007
Participating Start Date
4/1/2018
Last Recertification Date
9/9/2018
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
APOTHECARY & WELLNESS CENTER
Pharmacy Address
1450 CHAPEL STREET
NEW HAVEN, CT 06511-4405
Pharmacy Comments
Contract Details
Approval Date
3/2/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Seth Van Essendelft, CFO
(860) 442-0711 Ext: 2211
Contract Pharmacy Representative
Yale New Haven Health System
Marjorie Lazarre, Director, Pharmaceutical Procurement and Business Practices
(203) 688-7105
Signed By Date
3/2/2018
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