340B Drug Pricing Program Database
ACARIAHEALTH PHARMACY #12, INC.
DSH310019 St. Joseph’s University Medical Center - information as of 5/17/2025 12:43:50 AM
Covered Entity Details
Entity Name
St. Joseph’s University Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310019
Entity Address
703 MAIN STREET
PATERSON, NJ 07503
Medicare Provider Number
310019
Participating Start Date
10/1/2002
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY #12, INC.
Pharmacy Address
5 SKYLINE DR STE 240
HAWTHORNE, NY 10532-2166
Pharmacy Comments
Contract Details
Approval Date
1/8/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Slavin, President and CEO
(973) 754-2002 Ext: 9737542010
Contract Pharmacy Representative
Acaria Health
Philip Gofman, Regional VP
(917) 312-5263
Signed By Date
1/8/2018
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