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HARTFORD PHARMACY II
CH011830 CHARTER OAK HEALTH CENTER
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Covered Entity Details
Entity Name
CHARTER OAK HEALTH CENTER
Subdivision Name
CHARTER OAK HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH011830
Entity Address
21 Grand St
Hartford, CT 06106-1541
Grant Number
H80CS00153
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
HARTFORD PHARMACY II
Pharmacy Address
57 PARK ST
HARTFORD, CT 06106
Pharmacy Comments
Contract Details
Approval Date
4/3/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Nichele A. Mullins, President and CEO
(860) 550-7578
Contract Pharmacy Representative
Hartford Pharmacy
Pravin Dhulipalla, Owner
(860) 289-0000
Signed By Date
4/3/2018
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