340B Drug Pricing Program Database


DSH310074 JERSEY CITY MEDICAL CENTER (Active) - information as of 4/28/2025 1:48:35 AM

Main Details
JERSEY CITY MEDICAL CENTER
Disproportionate Share Hospital
No
DSH310074
310074


Additional Details
Active
10/18/2007
4/1/1997
10/18/2007
8/26/2024

Contacts

Jersey City Medical Center
Alexander Filipiak, Site Finance Officer
(973) 926-8208

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

Addresses

355 GRAND STREET
JERSEY CITY, NJ 07302

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
11/8/04 ADDED SHIP TO01/14/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NJ41398011689744856
CA 1689744856
CT 1689744856
MD 1689744856
MA 1689744856
NH 1689744856
NY 1689744856
NC 1689744856
PA 1689744856
TN 1689744856
WI 1689744856
AL 1689744856
AZ 1689744856
FL 1689744856
GA 1689744856
IA 1689744856
KY 1689744856
MN 1689744856
MO 1689744856
OH 1689744856
SC 1689744856
TX 1689744856
VA 1689744856
Shipping Addresses

JERSEY CITY MEDICAL CENTER
391 GRAND STREET - LOADING DOCK
JERSEY CITY, NJ 07302

Qualitas Pharmacy Services
615 Montrose Ave
South Plainfield, NJ 07080
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/25/201607/01/2016 01/01/201901/23/2019
Contract DetailACCREDO HEALTH GROUP INC201 GREAT CIRCLE ROAD
NASHVILLETN3722804/25/201607/01/2016 12/01/201701/20/2018
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/25/201607/01/2016 01/01/201901/23/2019
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/04/201707/01/2017 12/01/201701/20/2018
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/25/201607/01/2016 01/01/201901/23/2019
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/25/201607/01/2016 01/01/201901/23/2019
Contract DetailACCREDO HEALTH GROUP, INC.  PHARMACY
2 BOULDEN CIRCLE SUITE 1 		NEW CASTLEDE1972004/25/201607/01/2016  02/15/2017
Contract DetailAVELLA OF DEER VALLEY23620 N 20TH DR #12
PHOENIXAZ85085-062101/15/201804/01/2018 01/01/201901/23/2019
Contract DetailAVELLA OF DEER VALLEY, INC. #38DBA AVELLA SPECIALTY PHARMACY 24416 N. 19TH AVE
PHOENIXAZ8508501/15/201804/01/2018 01/01/201901/23/2019
Contract DetailAVELLA OF ORLANDO100 TECHNOLOGY PARK STE 155
LAKE MARYFL32746-620501/15/201804/01/2018 01/01/201901/23/2019
Contract DetailBARNABAS HEALTH RETAIL PHARMACYBARNABAS HEALTH RETAIL PHARMACY 355 GRAND ST
JERSEY CITYNJ0730201/10/201404/01/2014  02/15/2017
Contract DetailBARNABAS HEALTH RETAIL PHARMACYBARNABAS HEALTH RETAIL PHARMACY 1825 JOHN F KENNEDY BLVD
JERSEY CITYNJ0730504/16/201907/01/2019  07/01/2019
Contract DetailCOORDINATED CARE NETWORKCOORDINATED CARE NETWORK 300 PENN CENTER BLVD STE 405
PITTSBURGHPA15235-551101/16/202404/01/2024  04/01/2024
Contract DetailCOORDINATED CARE NETWORK PHARMACY268 MARTIN LUTHER KING JR. BLVD.
NEWARKNJ0710201/16/202404/01/2024  04/01/2024
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/18/202210/01/2022  10/01/2022
Contract DetailDUANE READE1 PATH PLAZA JOURNAL SQUARE
JERSEY CITYNJ0730601/10/201404/01/2014  02/15/2017
Contract DetailDUANE READE52 RIVER DRIVE S
JERSEY CITYNJ0731001/10/201404/01/2014 01/01/201901/23/2019
Contract DetailDUANE READE  1114 SPRINGFIELD AVE
IRVINGTONNJ0711101/10/201404/01/2014 01/04/201602/15/2017
Contract DetailDUANE READE PHCY. DEPT.110 NEWARK AVENUE
JERSEY CITYNJ0730201/10/201404/01/2014 03/01/202007/10/2020
Contract DetailDUANE READE PHCY. DEPT.110 NEWARK AVENUE
JERSEY CITYNJ0730201/12/202404/01/2024  04/01/2024
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/15/201610/01/2016 01/01/201901/23/2019
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/15/201610/01/2016 12/01/201701/27/2018
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/15/201610/01/2016  02/15/2017
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/15/201610/01/2016 12/01/201701/27/2018
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 255 PHILLIPI ROAD
COLUMBUSOH4322807/15/201610/01/2016 06/29/201810/27/2018
Contract DetailLIVINGSTON INFUSION CARE INCRWJBARNABAS HEALTH INFUSION AND SPECIALT 603 MONTROSE AVE
SOUTH PLAINFIELDNJ0708001/10/201404/01/2014  02/15/2017
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/26/202207/01/2022  07/01/2022
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/26/202207/01/2022  07/01/2022
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104204/06/202207/01/2022  07/01/2022
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022304/06/202207/01/2022  07/01/2022
Contract DetailWALGREEN EASTERN CO INCDBA: WALGREENS # 05463 699 BROADWAY
BAYONNENJ0700201/10/201404/01/2014 01/01/201901/23/2019
Contract DetailWALGREEN EASTERN CO INCDBA: WALGREENS # 05463 699 BROADWAY
BAYONNENJ0700201/12/202404/01/2024  04/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 16402 175 WASHINGTON AVE.
BELLEVILLENJ0710901/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02884 600 NEWARK AVE
ELIZABETHNJ0720801/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03146 561-579 IRVINGTON AVENUE
NEWARKNJ0710601/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03197 2395 KENNEDY BLVD.
JERSEY CITYNJ0730401/10/201404/01/2014  02/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #03292 240 CENTRAL AVE
ORANGENJ0705001/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03379 61 FERRY ST
NEWARKNJ0710501/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03431 2148 MORRIS AVE
UNIONNJ0708301/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05343 6012 KENNEDY BLVD WEST
WEST NEW YORKNJ0709301/10/201404/01/2014 01/01/201901/23/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06162 508 MARTIN LUTHER KING
EAST ORANGENJ07018-220701/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06253 1561 JOHN F KENNEDY BLVD
JERSEY CITYNJ07305-172101/10/201404/01/2014  02/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #12064 361 BERGEN ST.
NEWARKNJ0710301/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #13686 1633 SPRINGFIELD AVE.
MAPLEWOODNJ0704001/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #16260 36 HILLSIDE AVENUE
HILLSIDENJ0720501/10/201404/01/2014 02/02/201602/15/2017
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19708 395 DANFORTH AVE
JERSEY CITYNJ07305-197504/02/202407/01/2024 11/07/202411/07/2024
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528401/10/201404/01/2014 07/22/201502/15/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/18/202210/01/2022  10/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/18/202210/01/2022  10/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/18/202210/01/2022  10/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH310074AChildDSHJERSEY CITY MEDICAL CENTEROUTPATIENT PSYCHIATRY CLINICS395 GRAND STREETJERSEY CITYNJActive
DSH310074AAChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Emergency519 BROADWAYBAYONNENJActive
DSH310074ABChildDSHJERSEY CITY MEDICAL CENTERAmbulatory Surgery Center - Ambulatory Surgery Center377 Jersey AveJersey CityNJActive
DSH310074ACChildDSHJERSEY CITY MEDICAL CENTERGreenville Primary Care - Greenville Primary Care1825 John F. Kennedy BlvdJersey CityNJActive
DSH310074ADChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Pain Management Center414 GRAND STJERSEY CITYNJActive
DSH310074AEChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - GYN Clinic414 GRAND STJERSEY CITYNJActive
DSH310074AFChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Dermatology414 GRAND STJERSEY CITYNJActive
DSH310074AGChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - GYN Oncology414 GRAND STJERSEY CITYNJActive
DSH310074AHChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Orthopedics414 GRAND STJERSEY CITYNJActive
DSH310074AJChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Infusion Services at Jersey City Medical Center Specialty Care414 GRAND STJERSEY CITYNJActive
DSH310074AKChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - RWJBarnabas Health Rutgers NJMS Vascular Center377 JERSEY AVEJERSEY CITYNJActive
DSH310074ALChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Neurosurgery414 GRAND STJERSEY CITYNJActive
DSH310074AMChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Pediatrics414 GRAND STJERSEY CITYNJActive
DSH310074ANChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Urology414 GRAND STJERSEY CITYNJActive
DSH310074APChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Heart Failure414 GRAND STJERSEY CITYNJActive
DSH310074AQChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER - Infectious Disease414 GRAND STJERSEY CITYNJActive
DSH310074BChildDSHJERSEY CITY MEDICAL CENTERAIDS HEALTH SERVICES1825 JFK BLVDJERSEY CITYNJActive
DSH310074CChildDSHJERSEY CITY MEDICAL CENTERMATERNAL FETAL MEDICINE116 Newark AveJERSEY CITYNJActive
DSH310074DChildDSHJERSEY CITY MEDICAL CENTERLIBERTY WOUND418 SUMMIT AVEJERSEY CITYNJActive
DSH310074EChildDSHJERSEY CITY MEDICAL CENTEROPTHALMOLOGY418 SUMMIT AVEJERSEY CITYNJActive
DSH310074FChildDSHJERSEY CITY MEDICAL CENTERPSY ADULT PART HOSP395 GRAND STREETJERSEY CITYNJActive
DSH310074GChildDSHJERSEY CITY MEDICAL CENTERPSY ADULT OPD395 GRAND STREETJERSEY CITYNJActive
DSH310074HChildDSHJERSEY CITY MEDICAL CENTERCPHU AFTER SCHOOL395 GRAND STREETJERSEY CITYNJActive
DSH310074JChildDSHJERSEY CITY MEDICAL CENTERPSY CHILD OPD395 GRAND STREETJERSEY CITYNJActive
DSH310074KChildDSHJERSEY CITY MEDICAL CENTERPSY ADDICTION PROGRAM395 GRAND STREETJERSEY CITYNJActive
DSH310074LChildDSHJERSEY CITY MEDICAL CENTERPSY ADOL PART HOSP395 GRAND STREETJERSEY CITYNJActive
DSH310074MChildDSHJERSEY CITY MEDICAL CENTERPSY ADULT PH ACUTE395 GRAND STREETJERSEY CITYNJActive
DSH310074NChildDSHJERSEY CITY MEDICAL CENTERINTENSIVE OUTPATIENT SERVICES395 GRAND STREETJERSEY CITYNJActive
DSH310074PChildDSHJERSEY CITY MEDICAL CENTERPSY RESIDENTIAL SVC9 NUNDA AVEJERSEY CITYNJActive
DSH310074QChildDSHJERSEY CITY MEDICAL CENTERPSY SUPPORTIVE HOUSING395 GRAND STJERSEY CITYNJActive
DSH310074RChildDSHJERSEY CITY MEDICAL CENTERPSY INTGD CASE MGMT395 GRAND STREETJERSEY CITYNJActive
DSH310074SChildDSHJERSEY CITY MEDICAL CENTERTHERAPEUTIC NURSERY395 GRAND STREETJERSEY CITYNJActive
DSH310074TChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER / MENTALLY ILL (PATH)1825 JFK BLVDJERSEY CITYNJActive
DSH310074UChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER / CHILDREN CN SPEC NEEDS1825 JFK BLVDJERSEY CITYNJActive
DSH310074VChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER / RYAN WHITE FORMLA AIDS355 GRAND STREETJERSEY CITYNJActive
DSH310074WChildDSHJERSEY CITY MEDICAL CENTERJERSEY CITY MEDICAL CENTER / AIDS HEALTH SERVICES355 GRAND STREETJERSEY CITYNJActive
DSH310074XChildDSHJERSEY CITY MEDICAL CENTEROrthopedic Clinic253 Monmouth StreetJersey CityNJActive
DSH310074YChildDSHJERSEY CITY MEDICAL CENTERCARDIAC DIAGNOSTIC CENTER120 FRANKLIN STREETJERSEY CITYNJActive
DSH310074ZChildDSHJERSEY CITY MEDICAL CENTERDental Clinic - Dental418 Summit AveJersey CityNJActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification AL8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification AZ8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification FL8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification GA8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification IA8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification KY8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification MN8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification MO8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification OH8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification SC8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification TX8/26/2024 8:27 AM
Medicaid BillingNPI: NumberInsertRecertification 16897448568/26/2024 8:27 AM
Medicaid BillingNPI: StateInsertRecertification VA8/26/2024 8:27 AM
DetailsLast Recertification DateUpdateRecertification9/8/2023 1:23:35 PM8/26/2024 8:27:01 AM8/26/2024 8:27 AM
ContactsAuthorizing OfficialUpdateChange RequestZehner, Douglas Senior Vice President Jersey City Medical Center 9739266982Filipiak, Alexander Site Finance Officer Jersey City Medical Center 97392682087/30/2024 10:54 AM
ContactsAuthorizing OfficialUpdateChange RequestFilipiak, Alexander Site Finance Officer Jersey City Medical Center 7327890072Zehner, Douglas Senior Vice President Jersey City Medical Center 97392669825/31/2024 7:14 AM
ContactsAuthorizing OfficialUpdateChange RequestHollis, Carla COO Jersey City Medical Center 2019152944Filipiak, Alexander Site Finance Officer Jersey City Medical Center 73278900723/20/2024 7:30 AM
AddressesShipping AddressInsertRecertification Qualitas Pharmacy Services 615 Montrose Ave South Plainfield, NJ 070809/8/2023 1:23 PM
DetailsLast Recertification DateUpdateRecertification8/30/2022 8:46:11 AM9/8/2023 1:23:35 PM9/8/2023 1:23 PM
DetailsLast Recertification DateUpdateRecertification9/13/2021 3:58:21 PM8/30/2022 8:46:11 AM8/30/2022 8:46 AM
ContactsAuthorizing OfficialUpdateChange RequestValentine, Robert CFO Jersey City Medical Center 2015215920Hollis, Carla COO Jersey City Medical Center 20191529444/26/2022 12:43 PM
DetailsLast Recertification DateUpdateRecertification9/14/2020 3:47:15 PM9/13/2021 3:58:21 PM9/13/2021 3:58 PM
ContactsPrimary ContactUpdateProfile Change RequestMcCormick, Bryan 340B Program Manager RWJBarnabas Health 9733224022McCormick, Bryan Corporate Director 340B Program RWJBarnabas Health 97332240222/3/2021 5:53 PM
Medicaid BillingNPI: StateUpdateRecertification CA9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification NJ9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification CT9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification MD9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification MA9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification NH9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification NY9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification NC9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification PA9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification TN9/14/2020 3:47 PM
Medicaid BillingNPI: NumberInsertRecertification 16897448569/14/2020 3:47 PM
Medicaid BillingNPI: StateInsertRecertification WI9/14/2020 3:47 PM
DetailsLast Recertification DateUpdateRecertification9/15/2019 8:47:33 AM9/14/2020 3:47:15 PM9/14/2020 3:47 PM
ContactsPrimary ContactUpdateChange RequestPellechio, Robert VICE PRESIDENT, Corp Pharmacy RWJBarnabas 9733224327McCormick, Bryan 340B Program Manager RWJBarnabas Health 97332240224/30/2020 1:29 PM
DetailsLast Recertification DateUpdateRecertification9/6/2018 9:15:10 AM9/15/2019 8:47:33 AM9/15/2019 8:47 AM
DetailsLast Recertification DateUpdateRecertification11/16/2017 2:57:22 PM9/6/2018 9:15:10 AM9/6/2018 9:15 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestValentine, Robert Interim CFO Jersey City Medical Center 5512332111Valentine, Robert CFO Jersey City Medical Center 20152159209/6/2018 9:10 AM
DetailsLast Recertification DateUpdateRecertification8/18/2016 12:00:00 AM11/16/2017 2:57:22 PM11/16/2017 2:57 PM
ContactsAuthorizing OfficialUpdate Valentine, Robert Interim CFO 5512332111Valentine, Robert Interim CFO Jersey City Medical Center 551233211111/12/2017 11:02 AM
ContactsPrimary ContactUpdate Pellechio, Robert VICE PRESIDENT, Corp Pharmacy 9733224327Pellechio, Robert VICE PRESIDENT, Corp Pharmacy RWJBarnabas 97332243279/19/2017 10:37 AM
ContactsPrimary ContactUpdate CURCI, MICHAEL DIRECTOR OF PHARMACY 2019152062Pellechio, Robert VICE PRESIDENT, Corp Pharmacy 97332243278/8/2017 9:19 AM
ContactsAuthorizing OfficialUpdate Fitzpatrick, Sean CFO 2015215920Valentine, Robert Interim CFO 55123321118/8/2017 9:19 AM
AddressesMain AddressInsert   355 GRAND STREET JERSEY CITY, NJ 073027/25/2017 10:12 AM
AddressesShipping AddressInsert  JERSEY CITY MEDICAL CENTER 391 GRAND STREET - LOADING DOCK JERSEY CITY, NJ 073027/25/2017 10:12 AM
ContactsAuthorizing OfficialInsert  Fitzpatrick, Sean CFO 20152159205/2/2017 3:16 PM
DetailsLast Recertification DateUpdate 8/21/2015 12:00:00 AM8/18/2016 12:00:00 AM8/18/2016 11:36 AM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/21/2015 12:37 PM
Medicaid BillingMedicaid: NumberUpdate 31007441398018/21/2015 12:37 PM
DetailsLast Recertification DateUpdate 8/7/2014 12:00:00 AM8/21/2015 12:00:00 AM8/21/2015 12:37 PM
ContactsPrimary ContactInsert  CURCI, MICHAEL DIRECTOR OF PHARMACY 20191520628/7/2014 2:25 PM
DetailsLast Recertification DateUpdate 9/3/2013 12:00:00 AM8/7/2014 12:00:00 AM8/7/2014 2:25 PM
Medicaid BillingNPI: NumberInsert  16897448569/3/2013 1:37 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/3/2013 12:00:00 AM9/3/2013 1:37 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM6/28/2012 1:21 PM
DetailsLast Recertification DateInsert   1/14/2010 2:06 PM
DetailsGrant NumberInsert   1/14/2010 2:06 PM
Details340B IDInsert  DSH3100741/14/2010 2:06 PM
DetailsIs Authorizing Official EHB DataInsert   1/14/2010 2:06 PM
DatesLast Date That 340B Drugs PurchasedInsert   1/14/2010 2:06 PM
DetailsMedicare Provider NumberInsert  3100741/14/2010 2:06 PM
DetailsEntity NameInsert  JERSEY CITY MEDICAL CENTER1/14/2010 2:06 PM
DetailsProgram CodeInsert  DSH1/14/2010 2:06 PM
DetailsEntity SubnameInsert   1/14/2010 2:06 PM
DatesParticipating Approval DateInsert  10/18/2007 12:00:00 AM1/14/2010 2:06 PM
DetailsStateInsert  Active1/14/2010 2:06 PM
DatesRegistration DateInsert  10/18/2007 12:00:00 AM1/14/2010 2:06 PM
DatesSigned By DateInsert   1/14/2010 2:06 PM
DatesStart DateInsert  4/1/1997 12:00:00 AM1/14/2010 2:06 PM
TerminationsTermination CommentsInsert   1/14/2010 2:06 PM
TerminationsTermination DateInsert   1/14/2010 2:06 PM
TerminationsTermination Effective DateInsert   1/14/2010 2:06 PM
TerminationsTermination ReasonInsert   1/14/2010 2:06 PM
DetailsComments PublicInsert  11/8/04 ADDED SHIP TO1/14/2010 2:06 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True10/18/2007 6:37 AM
Medicaid BillingMedicaid: NumberInsert  31007410/18/2007 6:37 AM
Medicaid BillingMedicaid: StateInsert  NJ10/18/2007 6:37 AM