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RWI07304B JERSEY CITY MEDICAL CENTER (Terminated)
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Main Details
Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
CENTER FOR COMPREHENSIVE CARE
Type
Ryan White Part A
340B ID
RWI07304B
Grant Number
H89HA00003
Additional Details
Current Program Status
Terminated
Registration Date
4/1/2004
Participating Start Date
7/1/2013
Participating Approval Date
6/28/2013
Last Recertification Date
2/17/2020
Time Period the Assistance was Received
Termination Date
Termination Reason
4/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Jersey City Medical Center
Robert Valentine, CFO
(201) 521-5920
Primary Contact
RWJ Barnabas Health
Bob Pellechio, Vice President, Corp Pharmacy
(973) 322-4367
Addresses
Street Address
961 GARFIELD AVENUE
JERSEY CITY, NJ 07304
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History
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6/24/13 participating 4/1/04 thru 12/31/12, not participating 1/1/13 thru 6/30/13, re-instated effective 7/1/13 based on a new registration submitted; 8/11/10 UPDATED SUBDIV NAME (WAS COLUMBUS FAMILY HEALTH CENTER) ADDR (WAS 115 CHRISTOPHER COLUMBUS DRIVE) ADDED MEDICAD #; 5/22/07 ENT NAME MOD (WAS JERSEY CITY FAMILY HEALTH CENTER, INC.), MOD BILL TO NAME AND ADDR (WAS JERSEY CITY FAMILY HEALTH CENTER, INC., 935 GARFIELD AVENUE, ZIP 07304)
06/24/2013
8/11/10 UPDATED SUBDIV NAME (WAS COLUMBUS FAMILY HEALTH CENTER) ADDR (WAS 115 CHRISTOPHER COLUMBUS DRIVE) ADDED MEDICAD #; 5/22/07 ENT NAME MOD (WAS JERSEY CITY FAMILY HEALTH CENTER, INC.), MOD BILL TO NAME AND ADDR (WAS JERSEY CITY FAMILY HEALTH CENTER, INC., 935 GARFIELD AVENUE, ZIP 07304)
08/11/2010
May 2025
May 2025
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