340B Drug Pricing Program Database


DSH310075D MONMOUTH MEDICAL CENTER (Active) - information as of 5/25/2025 1:17:13 AM

Main Details
MONMOUTH MEDICAL CENTER
LAB AND XRAY
Disproportionate Share Hospital
No
DSH310075D
310075


Additional Details
Active
7/9/2015
10/1/2015
7/17/2015
8/22/2024

Contacts

Monmouth Medical Center
Cory Lasker, V.P. Financial Services
(732) 923-6289

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

Addresses

1910 HIGHWAY 35
OAKHURST, NJ 07755-2715

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NJ36758071609983790
CT 1609983790
MD 1609983790
NY 1609983790
NC 1609983790
PA 1609983790
TN 1609983790
VT 1609983790
VA 1609983790
WA 1609983790
WI 1609983790
AL 1609983790
CA 1609983790
CO 1609983790
FL 1609983790
MA 1609983790
MN 1609983790
MO 1609983790
TX 1609983790
UT 1609983790
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH310075AChildDSHMONMOUTH MEDICAL CENTERVantage Point Infusion Center100 State Highway 36west long branchNJActive
DSH310075BChildDSHMONMOUTH MEDICAL CENTERPSYCH CLINIC3301 HIGHWAY 66 BLDG B SUITE 201 EARLY INTERVENTION SUPPORT SERVICENEPTUNENJActive
DSH310075CChildDSHMONMOUTH MEDICAL CENTERPollak Clinic75 North Bath AvenueLong BranchNJActive
DSH310075DChildDSHMONMOUTH MEDICAL CENTERLAB AND XRAY1910 HIGHWAY 35OAKHURSTNJActive
DSH310075EChildDSHMONMOUTH MEDICAL CENTERJacqueline M. Wilentz Breast Center at Colts Neck310 Route 34, Second FloorColts NeckNJActive
DSH310075FChildDSHMONMOUTH MEDICAL CENTERJacqueline M. Wilentz Breast Center at Howell4013 Route 9HowellNJActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification AL8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification CA8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification CO8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification FL8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification MA8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification MN8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification MO8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification TX8/22/2024 12:01 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837908/22/2024 12:01 PM
Medicaid BillingNPI: StateInsertRecertification UT8/22/2024 12:01 PM
DetailsLast Recertification DateUpdateRecertification8/29/2023 9:54:28 AM8/22/2024 12:01:50 PM8/22/2024 12:01 PM
DetailsLast Recertification DateUpdateRecertification9/6/2022 9:48:38 AM8/29/2023 9:54:28 AM8/29/2023 9:54 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 11:45:44 AM9/6/2022 9:48:38 AM9/6/2022 9:48 AM
ContactsAuthorizing OfficialUpdateChange RequestAlexiades, Nikolas CFO RWJBarnabas Health 9739267824Lasker, Cory V.P. Financial Services Monmouth Medical Center 732923628910/22/2021 11:56 AM
DetailsLast Recertification DateUpdateRecertification9/11/2020 3:33:21 PM9/9/2021 11:45:44 AM9/9/2021 11:45 AM
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 CT9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification NJ9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification MD9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification NY9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification NC9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification PA9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification TN9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification VT9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification VA9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification WA9/11/2020 3:33 PM
Medicaid BillingNPI: NumberInsertRecertification 16099837909/11/2020 3:33 PM
Medicaid BillingNPI: StateInsertRecertification WI9/11/2020 3:33 PM
DetailsLast Recertification DateUpdateRecertification9/5/2019 12:10:23 PM9/11/2020 3:33:21 PM9/11/2020 3:33 PM
ContactsPrimary ContactUpdateChange RequestPellechio, Robert VICE PRESIDENT, Corp Pharmacy RWJBarnabas 9733224327McCormick, Bryan 340B Program Manager RWJBarnabas Health 97332240225/21/2020 1:02 PM
DetailsLast Recertification DateUpdateRecertification9/7/2018 3:39:18 PM9/5/2019 12:10:23 PM9/5/2019 12:10 PM
ContactsAuthorizing OfficialUpdateChange RequestZimmerman, Joanna Chief Financial Officer Monmouth Medical Center 7329237181Alexiades, Nikolas CFO RWJBarnabas Health 97392678246/12/2019 10:42 AM
DetailsLast Recertification DateUpdateRecertification11/14/2017 4:35:25 PM9/7/2018 3:39:18 PM9/7/2018 3:39 PM
DetailsLast Recertification DateUpdateRecertification8/30/2016 12:00:00 AM11/14/2017 4:35:25 PM11/14/2017 4:35 PM
ContactsAuthorizing OfficialUpdate Zimmerman, Joanna Chief Financial Officer 7329237181Zimmerman, Joanna Chief Financial Officer Monmouth Medical Center 732923718111/14/2017 4:30 PM
ContactsPrimary ContactUpdate Pellechio, Robert VICE PRESIDENT, Corp Pharmacy 9733224327Pellechio, Robert VICE PRESIDENT, Corp Pharmacy RWJBarnabas 97332243279/19/2017 10:37 AM
ContactsPrimary ContactInsert  Pellechio, Robert VICE PRESIDENT, Corp Pharmacy 97332243278/8/2017 9:19 AM
ContactsAuthorizing OfficialInsert  Zimmerman, Joanna Chief Financial Officer 73292371814/5/2017 11:36 AM
ContactsSigned ByInsert  McClung, David CFO 73292371811/12/2017 10:10 AM
AddressesMain AddressInsert   1910 HIGHWAY 35 OAKHURST, NJ 07755-27158/30/2016 2:54 PM
DetailsLast Recertification DateUpdate  8/30/2016 12:00:00 AM8/30/2016 2:54 PM
DatesParticipating Approval DateUpdate  7/17/2015 12:00:00 AM7/17/2015 10:09 AM
DetailsStateUpdate PendingActive7/17/2015 10:09 AM
DatesStart DateUpdate  10/1/2015 12:00:00 AM7/17/2015 10:09 AM
Details340B IDUpdate OUTPATIENT_ONLINE_REG_52727DSH310075D7/16/2015 12:35 PM
DetailsEntity SubnameUpdate MONMOUTH MEDICAL CENTERLAB AND XRAY7/16/2015 12:35 PM
Details340B IDUpdate  OUTPATIENT_ONLINE_REG_527277/9/2015 9:29 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False7/9/2015 9:29 AM
Medicaid BillingMedicaid: NumberInsert  36758077/9/2015 9:29 AM
Medicaid BillingMedicaid: StateInsert  NJ7/9/2015 9:29 AM
Medicaid BillingNPI: NumberInsert  16099837907/9/2015 9:29 AM
DetailsLast Recertification DateInsert   7/9/2015 9:29 AM
DetailsGrant NumberInsert   7/9/2015 9:29 AM
Details340B IDInsert   7/9/2015 9:29 AM
DetailsIs Authorizing Official EHB DataInsert   7/9/2015 9:29 AM
DatesLast Date That 340B Drugs PurchasedInsert   7/9/2015 9:29 AM
DetailsMedicare Provider NumberInsert  3100757/9/2015 9:29 AM
DetailsEntity NameInsert  MONMOUTH MEDICAL CENTER7/9/2015 9:29 AM
DetailsProgram CodeInsert  DSH7/9/2015 9:29 AM
DetailsEntity SubnameInsert  MONMOUTH MEDICAL CENTER7/9/2015 9:29 AM
DatesParticipating Approval DateInsert   7/9/2015 9:29 AM
DetailsStateInsert  Pending7/9/2015 9:29 AM
DatesRegistration DateInsert  7/9/2015 12:00:00 AM7/9/2015 9:29 AM
DatesSigned By DateInsert  7/9/2015 12:00:00 AM7/9/2015 9:29 AM
DatesStart DateInsert   7/9/2015 9:29 AM
TerminationsTermination CommentsInsert   7/9/2015 9:29 AM
TerminationsTermination DateInsert   7/9/2015 9:29 AM
TerminationsTermination Effective DateInsert   7/9/2015 9:29 AM
TerminationsTermination ReasonInsert   7/9/2015 9:29 AM