Covered Entity Details

DSH310027 TRINITAS REGIONAL MEDICAL CENTER (Active) - information as of 5/13/2025 11:00:56 PM

Main Details

Name

TRINITAS REGIONAL MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH310027

Medicare Provider Number

310027

Additional Details

Current Program Status

Active

Registration Date

1/11/2006

Participating Start Date

1/1/2005

Participating Approval Date

1/11/2006

Last Recertification Date

9/1/2024

Contacts

Authorizing Official

Trinitas Regional Medical Center
nancy DiLiegro, VP/coo
(973) 583-0405

Primary Contact

RWJBarnabas Health
Bryan McCormick, Corporate Director 340B Program
(973) 322-4022

Addresses

Street Address

225 WILLIAMSON ST
ELIZABETH, NJ 07202

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
10/5/11 UPDATED ENTITY NAME (WAS TRINITAS HOSPITAL), UPDATED ZIP (WAS 07207)	10/05/2011

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
AK	1684542
AL	222401
AZ	337801
CT	8001661
DC	14007205
FL	910470400
GA	003102073A
IL	223601678001
KY	7100409230
MA	110106748A
MD	9810081 00
NC	3100027	1669472882,1770583999
OH	2817714
PA	1019916650001
SC	11197B
TX	358599401
VA	10050235
WI	100058270
NJ	4136900	1770583999,1669472882
NY	03002802
CA		1669472882,1770583999
MN		1669472882,1770583999
MO		1669472882,1770583999

Shipping Addresses

Shipping Address 1

Trinitas Regional Medical Center
225 Williamson St.
Elizabeth, NJ 07202

Shipping Address 2

Qualitas Pharmacy Services
615 Montrose Ave.
South Plainfield, NJ 07080

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/15/2024	07/01/2024		07/01/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/15/2024	07/01/2024		07/01/2024
Contract Detail	AVELLA OF COLUMBUS	4830 KNIGHTSBRIDGE BLVD STE C		COLUMBUS	OH	43214-2300	07/18/2017	10/01/2017	12/06/2019	01/15/2020
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	07/18/2017	10/01/2017	12/06/2019	01/15/2020
Contract Detail	BERGEN PHARMACY	240 WILLIAMSON ST	STE 101	ELIZABETH	NJ	07202	01/13/2014	04/01/2014		07/13/2017
Contract Detail	BERGEN PHARMACY	SIDDHI GANESHA INC	655 E JERSEY ST	ELIZABETH	NJ	07206-1259	07/09/2018	10/01/2018		10/01/2018
Contract Detail	BERGEN PHARMACY	SIDDHI GANESHA INC	655 E JERSEY ST	ELIZABETH	NJ	07206-1259	07/09/2018	10/01/2018	06/12/2020	06/12/2020
Contract Detail	BERGEN PHARMACY	BERGEN PHARMACY	194 CLINTON AVE	NEWARK	NJ	07108-2809	01/14/2020	04/01/2020		04/01/2020
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	COMMCARE PHARMACY-FTL, LLC	855 SW 78TH AVE STE C100		PLANTATION	FL	33324-3223	01/08/2019	04/01/2019	05/06/2019	11/29/2019
Contract Detail	COMMUNITY PHARMACY	1089 ELIZABETH AVE	STOR # 5	ELIZABETH	NJ	07201	12/28/2011	01/02/2012	01/14/2022	04/08/2022
Contract Detail	CVS PHARMACY, INC.	3 BERRY DRIVE		LUMBERTON	NJ	08048	10/27/2014	01/01/2015	11/24/2015	07/13/2017
Contract Detail	ECKERD CORPORATION	RITE AID #10403	67 SAINT GEORGE AVENUE	ROSELLE	NJ	07203	01/21/2016	04/01/2016	02/15/2018	05/17/2018
Contract Detail	FRIENDLY PHARMACY	570 RARITAN RD		ROSELLE	NJ	07203-2446	07/13/2015	10/01/2015	06/01/2016	07/13/2017
Contract Detail	GOETHALS PHARMACY	GOETHALS PHARMACY	638 BAYWAY AVE	ELIZABETH	NJ	07202	03/13/2013	04/01/2013	06/01/2016	07/13/2017
Contract Detail	LEGACY DRUGSTORE, INC	400 S BROAD ST		ELIZABETH	NJ	07202	07/23/2014	10/01/2014	06/01/2016	07/13/2017
Contract Detail	LIVINGSTON INFUSION CARE INC	RWJBARNABAS HEALTH INFUSION AND SPECIALT	603 MONTROSE AVE	SOUTH PLAINFIELD	NJ	07080	04/08/2022	07/01/2022		07/01/2022
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00648	300 NORTH WOOD AVENUE	LINDEN	NJ	07036	10/16/2013	01/01/2014	11/24/2015	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00867	1000 S ELMORA AVE COLOR PLZ, SPACE D	ELIZABETH	NJ	07202	10/16/2013	01/01/2014	02/26/2017	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00905	890 SAINT GEORGE'S AVENUE	RAHWAY	NJ	07065	10/16/2013	01/01/2014	02/26/2017	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00955	430 WESTFIELD AVENUE	ELIZABETH	NJ	07208	10/16/2013	01/01/2014	02/26/2017	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02026	1105A MORRIS AVENUE	UNION	NJ	07083	10/16/2013	01/01/2014	02/26/2017	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02064	107 EAST FIRST AVENUE	ROSELLE	NJ	07203	10/16/2013	01/01/2014	02/26/2017	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04259	1319 MAGIE AVENUE	UNION	NJ	07083	10/16/2013	01/01/2014	02/26/2017	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07613	214 RAHWAY AVENUE	ELIZABETH	NJ	07202	10/16/2013	01/01/2014	02/26/2017	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00464	780 ROUTE 22 EAST	NORTH PLAINFIELD	NJ	07060-1613	10/16/2013	01/01/2014	11/24/2015	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02796	241 WESTFIELD AVENUE	CLARK	NJ	07066	10/16/2013	01/01/2014	11/24/2015	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04131	315 NORTH AVE.	GARWOOD	NJ	07027	10/16/2013	01/01/2014	11/24/2015	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05771	178 MORRIS AVE.	SPRINGFIELD	NJ	07081	10/16/2013	01/01/2014	11/24/2015	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06061	837 ROOSEVELT AVENUE	CARTERET	NJ	07008	10/16/2013	01/01/2014	11/24/2015	07/13/2017
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00867	1000 S ELMORA AVE COLOR PLZ, SPACE D	ELIZABETH	NJ	07202	07/12/2017	10/01/2017	10/04/2019	11/26/2019
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00955	430 WESTFIELD AVENUE	ELIZABETH	NJ	07208	07/12/2017	10/01/2017	10/04/2019	11/26/2019
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02064	107 EAST FIRST AVENUE	ROSELLE	NJ	07203	07/12/2017	10/01/2017	10/04/2019	11/26/2019
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04259	1319 MAGIE AVENUE	UNION	NJ	07083	07/12/2017	10/01/2017	10/04/2019	11/26/2019
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07613	214 RAHWAY AVENUE	ELIZABETH	NJ	07202	07/12/2017	10/01/2017	10/04/2019	11/26/2019
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	07/18/2017	10/01/2017	01/14/2022	04/08/2022
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/11/2023	07/01/2023		07/01/2023
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/11/2023	07/01/2023		07/01/2023
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	04/11/2023	07/01/2023		07/01/2023
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	04/11/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/12/2017	04/01/2017	11/06/2019	11/26/2019
Contract Detail	RITE AID NEW JERSEY, INC.	RITE AID #845	25 SOUTH BROAD STREET	ELIZABETH	NJ	07202	01/21/2016	04/01/2016	02/08/2018	05/17/2018
Contract Detail	RITE AID NEW JERSEY, INC.	RITE AID #1105	160 WASHINGTON AVENUE	CARTERET	NJ	07008	01/21/2016	04/01/2016	02/08/2018	05/17/2018
Contract Detail	RITE AID NEW JERSEY, INC.	RITE AID #3793	327 CHESTNUT STREET	UNION	NJ	07083	01/21/2016	04/01/2016	02/08/2018	05/17/2018
Contract Detail	RITE AID NEW JERSEY, INC.	RITE AID #4823	142 CENTRAL AVENUE	CLARK	NJ	07066	01/21/2016	04/01/2016	02/08/2018	05/17/2018
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	07/18/2017	10/01/2017		10/01/2017
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	04/08/2022	07/01/2022		07/01/2022
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	07/18/2017	10/01/2017		10/01/2017
Contract Detail	ST. GEORGES FAMILY PHARMACY	332 W SAINT GEORGES AVE		LINDEN	NJ	07036	07/23/2014	10/01/2014	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-2003	979 ROUTE 1 SOUTH		NORTH BRUNSWICK	NJ	08902	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-2633	1303 CENTENNIAL AVENUE		PISCATAWAY	NJ	08854	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-2825	1126 ROUTE 9		OLD BRIDGE	NJ	08857	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-3292	900 SPRINGFIELD ROAD		UNION	NJ	07083	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-3469	1050 W EDGAR RD		LINDEN	NJ	07036	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-3795	2100 88TH STREET		NORTH BERGEN	NJ	07047	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-5281	306 US HIGHWY 9 NORTH		WOODBRIDGE	NJ	07095	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WAL-MART PHARMACY 10-5447	150 HARRISON AVE		KEARNY	NJ	07032	01/18/2012	01/18/2012	06/01/2016	07/13/2017
Contract Detail	WALGREEN EASTERN CO., INC	RITE AID #10403	67 SAINT GEORGE AVE	ROSELLE	NJ	07203	06/18/2018	07/01/2018	02/26/2019	04/18/2019
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 02884	600 NEWARK AVE	ELIZABETH	NJ	07208	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06748	401 RAHWAY AVE	ELIZABETH	NJ	07202-2155	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04109	22 EAST ST GEORGES AVENUE	LINDEN	NJ	07036	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 06620	120 E 1ST AVENUE	ROSELLE	NJ	07203	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 03431	2148 MORRIS AVE	UNION	NJ	07083	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 04287	786 ST. GEORGES AVENUE	RAHWAY	NJ	07065	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS #16260	36 HILLSIDE AVENUE	HILLSIDE	NJ	07205	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 05248	1147 SOUTH AVENUE	PLAINFIELD	NJ	07062	08/13/2012	08/13/2012	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	DBA WALGREENS SPECIALTY PHARMACY #16416	191 CENTRAL AVE STE 102	NEWARK	NJ	07103	01/13/2017	04/01/2017	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18277	25 S BROAD ST	ELIZABETH	NJ	07202-3401	06/18/2018	07/01/2018	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18312	142 CENTRAL AVE	CLARK	NJ	07066	06/18/2018	07/01/2018	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17957	327 CHESTNUT ST	UNION	NJ	07083	06/18/2018	07/01/2018	01/07/2020	01/15/2020
Contract Detail	WALGREEN EASTERN CO., INC.	RITE AID #01105	160 WASHINGTON AVE	CARTERET	NJ	07008	06/18/2018	07/01/2018	09/12/2018	04/18/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH310027A	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	TRINITAS COMPREHENSIVE CANCER CENTER	225 WILLIAMSON ST, SUITE 124	ELIZABETH	NJ	Active
DSH310027B	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	LINDEN RENAL DIALYSIS	10 NORTH WOOD AVE	LINDEN	NJ	Active
DSH310027C	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	Medical Arts Center Dialysis	200 Williamson Street	ELIZABETH	NJ	Active
DSH310027D	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	PSYCHIATRY	655 EAST JERSEY ST	ELIZABETH	NJ	Active
DSH310027E	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	AMBULANCE	225 WILLIAMSON ST	ELIZABETH	NJ	Terminated
DSH310027G	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	WOMEN'S HEALTH CENTER	200 Williamson Street	ELIZABETH	NJ	Active
DSH310027H	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	PEDIATRIC HEALTH CENTER	200 Williamson Street	ELIZABETH	NJ	Active
DSH310027I	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	MEDICAL CLINIC	655 EAST JERSEY ST	ELIZABETH	NJ	Active
DSH310027L	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	BROTHER BONAVENTURE	655 EAST JERSEY ST	ELIZABETH	NJ	Terminated
DSH310027M	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	COMMUNITY MOBILE RESPONSE	655 EAST JERSEY ST	ELIZABETH	NJ	Terminated
DSH310027N	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	YOUTH CASE MANAGEMENT/INTENSIVE-IN COMMUNITY	655 EAST JERSEY ST	ELIZABETH	NJ	Terminated
DSH310027O	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	WORK FIRST	655 EAST JERSEY ST	ELIZABETH	NJ	Active
DSH310027P	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	EIP (EARLY INTERVENTION PROGRAM)	655 LIVINGSTON STREET	ELIZABETH	NJ	Active
DSH310027Q	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	CHILD DAY TREATMENT - PSYCHIATRY	655 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027R	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	ADULT PSYCH OUTPATIENT CLINIC - PSYCHIATRY	654 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027S	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	ADULT PARTIAL HOSPITAL - PSYCHIATRY	654 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027T	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	SUBSTANCE ABUSE CLINIC - PSYCHIATRY	654 EAST JERSEY STREET	ELIZABETH	NJ	Active
DSH310027U	Child	DSH	TRINITAS REGIONAL MEDICAL CENTER	CRANFORD RENAL DIALYSIS - DIALYSIS	205 Birchwood Avenue	Cranford	NJ	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	NPI: Number	Insert	Recertification		1669472882	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770583999	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	9/1/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669472882	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770583999	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MN	9/1/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669472882	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770583999	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		MO	9/1/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1669472882	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2024 7:34 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1770583999	9/1/2024 7:34 PM
Medicaid Billing	NPI: State	Insert	Recertification		NC	9/1/2024 7:34 PM
Details	Last Recertification Date	Update	Recertification	8/30/2023 3:38:05 PM	9/1/2024 7:34:23 PM	9/1/2024 7:34 PM
Addresses	Shipping Address	Insert	Recertification		Trinitas Regional Medical Center 225 Williamson St. Elizabeth, NJ 07202	8/30/2023 3:38 PM
Addresses	Shipping Address	Insert	Recertification		Qualitas Pharmacy Services 615 Montrose Ave. South Plainfield, NJ 07080	8/30/2023 3:38 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 6:58:17 PM	8/30/2023 3:38:05 PM	8/30/2023 3:38 PM
Contacts	Authorizing Official	Update	AO Change Request	DiLiegro, Nancy Vice President of Clinical Operations and Physician Services, Chief Clinical Officer Trinitas regional medical center 9089945226	DiLiegro, nancy VP/coo Trinitas Regional Medical Center 9735830405	4/11/2023 11:19 AM
Details	Last Recertification Date	Update	Recertification	8/24/2021 12:39:14 PM	9/14/2022 6:58:17 PM	9/14/2022 6:58 PM
Contacts	Primary Contact	Update	Change Request	Greasheimer, Sharon DIRECTOR OF PHARMACY Trinitas Regional Medical Center 9089945238	McCormick, Bryan Corporate Director 340B Program RWJBarnabas Health 9733224022	7/19/2022 6:58 AM
Details	Last Recertification Date	Update	Recertification	9/7/2020 9:55:02 AM	8/24/2021 12:39:14 PM	8/24/2021 12:39 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 12:35:37 PM	9/7/2020 9:55:02 AM	9/7/2020 9:55 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1669472882	8/11/2020 1:53 PM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	8/11/2020 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1684542	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		222401	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AL	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		337801	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		8001661	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		14007205	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DC	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		910470400	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003102073A	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		223601678001	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7100409230	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110106748A	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9810081 00	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MD	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3100027	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		2817714	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1019916650001	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		11197B	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		358599401	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TX	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10050235	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100058270	6/12/2020 3:09 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	6/12/2020 3:09 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 12:57:06 PM	9/5/2019 12:35:37 PM	9/5/2019 12:35 PM
Details	Last Recertification Date	Update	Recertification	11/29/2017 7:46:38 PM	8/28/2018 12:57:06 PM	8/28/2018 12:57 PM
Contacts	Authorizing Official	Update	Change Request	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948174	DiLiegro, Nancy Vice President of Clinical Operations and Physician Services, Chief Clinical Officer Trinitas regional medical center 9089945226	4/24/2018 2:22 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/5/2018 10:45 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		03002802	1/5/2018 10:45 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	1/5/2018 10:45 AM
Details	Last Recertification Date	Update	Recertification	9/3/2016 12:00:00 AM	11/29/2017 7:46:38 PM	11/29/2017 7:46 PM
Contacts	Authorizing Official	Update	Profile Change Request	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948071	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948174	11/10/2017 7:51 AM
Contacts	Authorizing Official	Update		LUMPP, KAREN CFO & SENIOR VP 9089948071	LUMPP, KAREN CFO & SENIOR VP Trinitas Regional Medical Center 9089948071	11/10/2017 7:49 AM
Contacts	Primary Contact	Update		Greasheimer, Sharon DIRECTOR OF PHARMACY 9089945238	Greasheimer, Sharon DIRECTOR OF PHARMACY Trinitas Regional Medical Center 9089945238	11/9/2017 5:09 PM
Contacts	Authorizing Official	Update		VILLARES, FRANK CFO 9089948071	LUMPP, KAREN CFO & SENIOR VP 9089948071	7/18/2017 9:27 AM
Contacts	Primary Contact	Update		KREMPA, CHERYL PHARMACY MANAGER 9089945238	Greasheimer, Sharon DIRECTOR OF PHARMACY 9089945238	7/13/2017 1:35 PM
Addresses	Main Address	Insert			225 WILLIAMSON ST ELIZABETH, NJ 07202	7/13/2017 1:35 PM
Details	Last Recertification Date	Update		8/21/2015 12:00:00 AM	9/3/2016 12:00:00 AM	9/3/2016 1:17 PM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/21/2015 12:00:00 AM	8/31/2015 3:55 PM
Details	Last Recertification Date	Update		9/11/2013 12:00:00 AM	9/3/2014 12:00:00 AM	9/3/2014 1:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/1/2013 7:51 AM
Medicaid Billing	Medicaid: Number	Insert			4136900	10/1/2013 7:51 AM
Medicaid Billing	Medicaid: State	Insert			NJ	10/1/2013 7:51 AM
Medicaid Billing	NPI: Number	Insert			1770583999	10/1/2013 7:51 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/11/2013 12:00:00 AM	9/11/2013 12:46 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 8:49 AM
Contacts	Authorizing Official	Insert			VILLARES, FRANK CFO 9089948071	12/21/2011 2:41 PM
Details	Entity Name	Update		TRINITAS HOSPITAL	TRINITAS REGIONAL MEDICAL CENTER	10/5/2011 2:25 PM
Details	Comments Public	Insert			10/5/11 UPDATED ENTITY NAME (WAS TRINITAS HOSPITAL), UPDATED ZIP (WAS 07207)	10/5/2011 2:25 PM
Contacts	Primary Contact	Insert			KREMPA, CHERYL PHARMACY MANAGER 9089945238	12/20/2007 9:16 AM
Details	Last Recertification Date	Insert				12/20/2007 9:16 AM
Details	Grant Number	Insert				12/20/2007 9:16 AM
Details	340B ID	Insert			DSH310027	12/20/2007 9:16 AM
Details	Is Authorizing Official EHB Data	Insert				12/20/2007 9:16 AM
Dates	Last Date That 340B Drugs Purchased	Insert				12/20/2007 9:16 AM
Details	Medicare Provider Number	Insert			310027	12/20/2007 9:16 AM
Details	Entity Name	Insert			TRINITAS HOSPITAL	12/20/2007 9:16 AM
Details	Program Code	Insert			DSH	12/20/2007 9:16 AM
Details	Entity Subname	Insert				12/20/2007 9:16 AM
Dates	Participating Approval Date	Insert			1/11/2006 12:00:00 AM	12/20/2007 9:16 AM
Details	State	Insert			Active	12/20/2007 9:16 AM
Dates	Registration Date	Insert			1/11/2006 12:00:00 AM	12/20/2007 9:16 AM
Dates	Signed By Date	Insert				12/20/2007 9:16 AM
Dates	Start Date	Insert			1/1/2005 12:00:00 AM	12/20/2007 9:16 AM
Terminations	Termination Comments	Insert				12/20/2007 9:16 AM
Terminations	Termination Date	Insert				12/20/2007 9:16 AM
Terminations	Termination Effective Date	Insert				12/20/2007 9:16 AM
Terminations	Termination Reason	Insert				12/20/2007 9:16 AM