| Details | State | Update | | To Be Terminated | Terminated | 4/1/2022 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 12/31/2020 12:00:00 AM | 2/3/2022 12:10 PM |
| Details | State | Update | Recertification | Active | To Be Terminated | 2/3/2022 12:10 PM |
| Terminations | Termination Comments | Update | Recertification | | Site closed in late 2020/early 2021. | 2/3/2022 12:10 PM |
| Terminations | Termination Date | Update | Recertification | | 4/1/2022 12:00:00 AM | 2/3/2022 12:10 PM |
| Terminations | Termination Effective Date | Update | Recertification | | 12/31/2020 12:00:00 AM | 2/3/2022 12:10 PM |
| Terminations | Termination Reason | Update | Recertification | | Site closure | 2/3/2022 12:10 PM |
| Addresses | Main Address | Update | Recertification |
857 Bergen Ave
Jersey City, NJ 07306-4405 |
935 Garfield Ave.
Jersey City, NJ 07304-4405 | 2/10/2021 9:02 AM |
| Addresses | Billing Address | Update | Recertification | Metropolitan Family Health Network, Inc.
935 GARFIELD AVE.
JERSEY CITY, NJ 07304 | MFHN
935 GARFIELD AVE.
JERSEY CITY, NJ 07304 | 2/10/2021 9:02 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/10/2021 9:02 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 0107964 | 2/10/2021 9:02 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | NJ | 2/10/2021 9:02 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1417967456 | 2/10/2021 9:02 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NJ | 2/10/2021 9:02 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1982846879 ( ) | | 2/10/2021 9:02 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2020 10:19:24 AM | 2/10/2021 9:02:50 AM | 2/10/2021 9:02 AM |
| Details | Last Recertification Date | Update | Recertification | 2/1/2019 10:15:03 AM | 1/30/2020 10:19:24 AM | 1/30/2020 10:19 AM |
| Details | Last Recertification Date | Update | Recertification | 2/26/2018 12:03:07 PM | 2/1/2019 10:15:03 AM | 2/1/2019 10:15 AM |
| Addresses | Billing Address | Update | Recertification |
935 GARFIELD AVE.
JERSEY CITY, NJ 07304 | Metropolitan Family Health Network, Inc.
935 GARFIELD AVE.
JERSEY CITY, NJ 07304 | 2/26/2018 12:03 PM |
| Addresses | Shipping Address | Insert | Recertification | | Metropolitan Family Health Network
Healthcare Pharmacy
935 Garfield Ave.
Jersey City, NJ 07304 | 2/26/2018 12:03 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1982846879 | 2/26/2018 12:03 PM |
| Details | Last Recertification Date | Update | Recertification | 1/27/2017 12:00:00 AM | 2/26/2018 12:03:07 PM | 2/26/2018 12:03 PM |
| Contacts | Authorizing Official | Update | | Dublin, Joan
CEO
2014785802 | Dublin, Joan
CEO
Metropolitan Family Health Network
2014785802 | 2/23/2018 11:21 AM |
| Contacts | Primary Contact | Update | | Carey, Scott
COO
2014785829 | Carey, Scott
COO
Metropolitan Family Health Network Inc.
2014785829 | 2/9/2018 5:10 PM |
| Addresses | Main Address | Insert | | |
857 Bergen Ave
Jersey City, NJ 07306-4405 | 1/27/2017 10:41 AM |
| Contacts | Authorizing Official | Insert | | | Dublin, Joan
CEO
2014785802 | 1/27/2017 10:41 AM |
| Contacts | Primary Contact | Insert | | | Carey, Scott
COO
2014785829 | 1/27/2017 10:41 AM |
| Details | Last Recertification Date | Update | | 2/22/2016 12:00:00 AM | 1/27/2017 12:00:00 AM | 1/27/2017 10:41 AM |
| Details | Last Recertification Date | Update | | 1/28/2015 12:00:00 AM | 2/22/2016 12:00:00 AM | 2/22/2016 10:03 AM |
| Details | Last Recertification Date | Update | | 2/10/2014 12:00:00 AM | 1/28/2015 12:00:00 AM | 1/28/2015 9:41 AM |
| Details | Entity Name | Update | | METROPOLITAN FAMILY HEALTH NETWORK | METROPOLITAN FAMILY HEALTH NETWORK INC. | 3/31/2014 4:25 PM |
| Details | Entity Subname | Update | | SATELLITE LOCATION | Metropolitan Family Health Network, Inc. at Bergen Avenue. | 3/31/2014 4:25 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/10/2014 12:00:00 AM | 2/10/2014 10:44 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/1/2013 12:03 PM |
| Addresses | Billing Address | Insert | | |
935 GARFIELD AVE.
JERSEY CITY, NJ 07304 | 4/19/2010 9:37 AM |
| Details | Last Recertification Date | Insert | | | | 4/19/2010 9:37 AM |
| Details | Grant Number | Insert | | | H80CS07588 | 4/19/2010 9:37 AM |
| Details | 340B ID | Insert | | | CH021771B | 4/19/2010 9:37 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/19/2010 9:37 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/19/2010 9:37 AM |
| Details | Medicare Provider Number | Insert | | | | 4/19/2010 9:37 AM |
| Details | Entity Name | Insert | | | METROPOLITAN FAMILY HEALTH NETWORK | 4/19/2010 9:37 AM |
| Details | Program Code | Insert | | | CH | 4/19/2010 9:37 AM |
| Details | Entity Subname | Insert | | | SATELLITE LOCATION | 4/19/2010 9:37 AM |
| Dates | Participating Approval Date | Insert | | | 3/3/2010 12:00:00 AM | 4/19/2010 9:37 AM |
| Details | State | Insert | | | Active | 4/19/2010 9:37 AM |
| Dates | Registration Date | Insert | | | 3/3/2010 12:00:00 AM | 4/19/2010 9:37 AM |
| Dates | Signed By Date | Insert | | | 1/1/2010 12:00:00 AM | 4/19/2010 9:37 AM |
| Dates | Start Date | Insert | | | 4/1/2010 12:00:00 AM | 4/19/2010 9:37 AM |
| Terminations | Termination Comments | Insert | | | | 4/19/2010 9:37 AM |
| Terminations | Termination Date | Insert | | | | 4/19/2010 9:37 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/19/2010 9:37 AM |
| Terminations | Termination Reason | Insert | | | | 4/19/2010 9:37 AM |