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Licensed Pharmacies Based on State Licenses and Credentials

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Licensed Pharmacies Based on State Licenses and Credentials Licensed Pharmacies Based on State Licenses and Credentials CredentialId Name Type 1002539 WASHINGTON HEALTH LIMITED LIABILITY CENTER & PHARMACY COMPANY 1133657 HANCOCK PHARMACY III LIMITED LIABILITY LLC COMPANY 1146910 NEW BRITAIN PHARMACY LIMITED LIABILITY COMPANY 1005767 CVSSSSSS CORPORATION 1511053 NOSTRUM RX PHARMACY LIMITED LIABILITY COMPANY 1504051 UCONN HEALTH CORPORATION PHARMACY SERVICES INC 1524433 BIG Y PHARMACY #109 BUSINESS 165876 CVS PHARMACY #1139 CORPORATION 390387 CVS PHARMACY #350 LIMITED LIABILITY COMPANY 1026099 BIG Y PHARMACY #55 CORPORATION 1027923 PHARMSCRIPT LLC LIMITED LIABILITY COMPANY 228049 WALGREENS #03359 CORPORATION 239701 CVS PHARMACY #1027 CORPORATION 39111 CVS PHARMACY #1903 LIMITED LIABILITY COMPANY 2226125 LOFT CHEMISTS LLC LIMITED LIABILITY Page 1 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials BusinessName DBA WASHINGTON HEALTH CENTER & PHARMACY HANCOCK PHARMACY III LLC NEW BRITAIN PHARMACY CVSSSSSS NOSTRUM RX PHARMACY NOSTRUMRX PHARMACY UCONN HEALTH PHARMACY SERVICES INC BIG Y PHARMACY #109 CVS PHARMACY #1139 CVS PHARMACY #350 BIG Y PHARMACY #55 PHARMSCRIPT LLC WALGREENS #03359 CVS PHARMACY #1027 CVS PHARMACY #1903 LOFT CHEMISTS LLC Page 2 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials FullCredentialCode CredentialType PCY.0002216 PCY PCY.0002256 PCY PCY.0002260 PCY PCY.0002217 PCY PCY.0002373 PCY PCY.0002372 PCY PCY.0002377 PCY PCY.0001576 PCY PCY.0001939 PCY PCY.0002219 PCY PCY.0002220 PCY PCY.0001539 PCY PCY.0001318 PCY PCY.0001499 PCY PCY.0002436 PCY Page 3 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials CredentialNumber CredentialSubCategory 2216 2256 2260 2217 2373 2372 2377 1576 1939 2219 2220 1539 1318 1499 2436 Page 4 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials Credential Status StatusReason PHARMACY INACTIVE PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY INACTIVE PHARMACY INACTIVE PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED Page 5 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials Active IssueDate EffectiveDate 0 10/28/2011 09/01/2016 1 07/09/2013 09/01/2021 1 04/12/2013 09/01/2021 0 1 09/04/2018 09/01/2021 1 05/16/2018 09/01/2021 1 12/11/2018 09/01/2021 1 03/24/2004 09/01/2021 0 0 11/09/2011 07/02/2019 0 1 09/01/2004 09/01/2021 1 09/01/2004 09/01/2021 1 02/15/2005 09/01/2021 0 Page 6 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials ExpirationDate Address City 08/31/2017 5 BRYAN HALL PLAZA WASHINGTON DEPOT 08/31/2022 3768 MAIN ST BRIDGEPORT 08/31/2022 46 BROAD ST NEW BRITAIN 526 MERIDEN RD WATERBURY 08/31/2022 2286 BERLIN TPKE NEWINGTON 08/31/2022 270 FARMINGTON AVE STE 108 FARMINGTON 08/31/2022 7 E HAMPTON RD # RT 66 MARLBOROUGH 08/31/2022 2610 E MAIN ST BRIDGEPORT 566 FARMINGTON AVE HARTFORD 08/31/2019 830 BOSTON POST RD GUILFORD 150 PIERCE ST SOMERSET 08/31/2022 1606 BARNUM AVE STRATFORD 08/31/2022 372 W MAIN ST NORWICH 08/31/2022 824 PARK AVE BLOOMFIELD 1184-1186 MAIN STREET BRIDGEPORT Page 7 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials State Zip RecordRefreshedOn CT 06794 03/07/2017 CT 066063610 07/26/2021 CT 060534305 07/26/2021 CT 067052217 07/07/2011 CT 061113202 07/26/2021 CT 060321965 07/26/2021 CT 064471402 07/26/2021 CT 066101422 09/02/2021 CT 061053050 07/04/2008 CT 064372701 07/19/2019 NJ 088734185 08/05/2011 CT 066145301 09/02/2021 CT 063605421 09/02/2021 CT 06002 09/02/2021 CT 06604 06/15/2021 Page 8 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials COMPANY 1031123 RITE AID #4778 BUSINESS 249877 BISSELL PHARMACY BUSINESS 37117 SHARON PHARMACY CORPORATION 37989 GRADE A PHARMACY CORPORATION 37998 BELLA VISTA PHARMACY CORPORATION INC 38003 BEACON PRESCRIPTIONS CORPORATION 404381 BIG Y PHARMACY #81 CORPORATION 457835 BIG Y PHARMACY #82 CORPORATION 488181 BIG Y PHARMACY #87 CORPORATION 488798 BIG Y # 84 CORPORATION 912512 SHOPRITE PHARMACY OF COMPANY SHELTON 1041038 VARNUMS PHARMACY LIMITED LIABILITY COMPANY 1041539 WALGREENS #15358 LIMITED LIABILITY COMPANY 1044750 WOODBRIDGE PHARMACY LIMITED LIABILITY COMPANY 975285 BEACON MEDICATION BUSINESS SERVICES 986516 ENGLISH APOTHECARY LIMITED LIABILITY COMPANY Page 9 of 784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials RITE AID #4778 BISSELL PHARMACY SHARON PHARMACY GRADE A PHARMACY GRADE A MARKET BELLA VISTA PHARMACY INC BEACON PRESCRIPTIONS BIG Y PHARMACY #81 BIG Y PHARMACY #82 BIG Y PHARMACY #87 BIG Y # 84 SHOPRITE PHARMACY OF SHELTON VARNUMS PHARMACY WALGREENS #15358 WOODBRIDGE PHARMACY BEACON MEDICATION SERVICES BEACON MEDICATION SERVICES ENGLISH APOTHECARY Page 10 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials PCY.0002222 PCY PCY.0000023 PCY PCY.0000294 PCY PCY.0000033 PCY PCY.0001063 PCY PCY.0001086 PCY PCY.0001983 PCY PCY.0002078 PCY PCY.0002102 PCY PCY.0002103 PCY PCY.0002161 PCY PCY.0002224 PCY PCY.0002227 PCY PCY.0002229 PCY PCY.0002195 PCY PCY.0002208 PCY Page 11 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials 2222 23 294 33 1063 1086 1983 2078 2102 2103 2161 2224 2227 2229 2195 2208 Page 12 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY INACTIVE PHARMACY INACTIVE WITHDRAWN PHARMACY ACTIVE CURRENT PHARMACY ACTIVE CURRENT Page 13 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials 0 1 06/29/2005 09/01/2021 1 09/01/2004 09/01/2021 1 09/01/2021 1 09/01/2021 1 09/01/2021 1 07/08/2005 09/01/2021 1 03/21/2007 09/01/2021 1 01/23/2008 09/01/2021 1 01/23/2008 09/01/2021 1 04/01/2010 09/01/2021 0 0 03/29/2012 09/01/2017 0 1 07/12/2011 09/01/2021 1 07/19/2011 09/01/2021 Page 14 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials 588 MAIN ST EAST HAVEN 08/31/2022 23 GOVERNOR ST RIDGEFIELD 08/31/2022 8 GAY ST SHARON 08/31/2022 200 SHIPPAN AVE STAMFORD 08/31/2022 321 EASTERN ST NEW HAVEN 08/31/2022 57 SOUTH ST BRISTOL 08/31/2022 33 FIELDSTONE COMMONS TOLLAND 08/31/2022 81 STONY HILL RD BETHEL 08/31/2022 1289 FOXON RD NORTH BRANFORD 08/31/2022 355 HAWLEY LN STRATFORD 08/31/2022 875 BRIDGEPORT AVE SHELTON 91 MAIN ST NEW CANAAN 08/31/2018 2200 ATLANTIC ST STE 200 STAMFORD 245 AMITY RD STE 111 WOODBRIDGE 08/31/2022 25 MELLEN ST BRISTOL 08/31/2022 140 GREENWOOD AVE BETHEL Page 15 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials CT 065122001 08/26/2011 CT 068774687 07/26/2021 CT 060690116 07/26/2021 CT 069026013 07/26/2021 CT 065132400 07/26/2021 CT 060106524 07/26/2021 CT 06084 07/26/2021 CT 068013038 07/26/2021 CT 064711289 07/26/2021 CT 066141514 07/26/2021 CT 064844621 07/26/2021 CT 068404757 11/14/2011 CT 069026834 09/29/2017 CT 065252258 07/24/2014 CT 060106313 07/26/2021 CT 068012530 07/26/2021 Page 16 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials 1046633 SHOPRITE PHARMACY OF COMPANY WEST HAVEN 1048075 NEWTOWN PHARMACY LLC LIMITED LIABILITY COMPANY 2208016 THOMASTON PHARMACY LIMITED LIABILITY PLLC COMPANY 1050824 SIRA PHARMACY LLC LIMITED LIABILITY COMPANY 1054632 DOYLE'S DRUG LIMITED LIABILITY COMPANY 1056204 RONALD P ALGIERI INDIVIDUAL 1056525 MYBRAND-RX LIMITED LIABILITY COMPANY 1067036 HANCOCK PHARMACY IV LIMITED LIABILITY LLC COMPANY 1067310 UNIVERSITY OF CORPORATION CONNECTICUT HEALTH SERVICES PHARMACY 1071063 KIRAN FATIMA SYED INDIVIDUAL 1077714 QUALICARE PHARMACY, LIMITED LIABILITY LLC COMPANY 1078822 BEACON PRESCRIPTIONS BUSINESS 1078962 APOTHECARY & WELLNESS BUSINESS CENTER 1081997 WALGREENS #15389 CORPORATION Page 17 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials SHOPRITE PHARMACY OF WEST HAVEN NEWTOWN PHARMACY LLC THOMASTON PHARMACY PLLC THOMASTON HEALTH MART PHARMACY SIRA PHARMACY LLC MEDICINE SHOPPE (THE) DOYLE'S DRUG DOYLES' GENERAL STORE LLC MYBRAND-RX HANCOCK PHARMACY IV LLC UNIVERSITY OF CONNECTICUT HEALTH SERVICES PHARMACY QUALICARE PHARMACY, LLC BEACON PRESCRIPTIONS APOTHECARY & WELLNESS CENTER WALGREENS #15389 Page 18 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials PCY.0002230 PCY PCY.0002231 PCY PCY.0002432 PCY PCY.0002232 PCY PCY.0002233 PCY PCY.0002234 PCY PCY.0002235 PCY PCY.0002238 PCY PCY.0002239 PCY PCY.0002240 PCY PCY.0002242 PCY PCY.0002243 PCY PCY.0002244 PCY PCY.0002245 PCY Page 19 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials 2230 2231 2432 2232 2233 2234 2235 2238 2239 2240 2242 2243 2244 2245 Page 20 of784 09/24/2021 Licensed Pharmacies Based on State Licenses and Credentials PHARMACY INACTIVE PHARMACY INACTIVE PHARMACY ACTIVE CURRENT PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY INACTIVE PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY INACTIVE PHARMACY INACTIVE WITHDRAWN PHARMACY PENDING NEW APPLICATION REVIEW REQUIRED PHARMACY INACTIVE WITHDRAWN PHARMACY
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