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MY FAIR HAVEN PHARMACY LLC
CH010070 CORNELL SCOTT-HILL HEALTH CORPORATION
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Covered Entity Details
Entity Name
CORNELL SCOTT-HILL HEALTH CORPORATION
Subdivision Name
CORNELL SCOTT-HILL HEALTH CORPORATION
Type
HRSA-Funded Health Center
340B ID
CH010070
Entity Address
400-428 COLUMBUS AVENUE
NEW HAVEN, CT 06519-1233
Grant Number
H80CS00312
Participating Start Date
12/1/1992
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
MY FAIR HAVEN PHARMACY LLC
Pharmacy Address
D/B/A FAIR HAVEN PHARMACY
72 GRAND AVE
NEW HAVEN, CT 06513
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL R. TAYLOR, CEO
(203) 503-3274
Contract Pharmacy Representative
MY FAIR HAVEN PHARMACY LLC
Manthena Varma, member
(203) 498-3479
Signed By Date
4/16/2018
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