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RWI07304D JERSEY CITY MEDICAL CENTER (Terminated)
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Main Details
Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
MEDICAL AND SOCIAL SERVICES FOR THE HOMELESS (MASSH)
Type
Ryan White Part A
340B ID
RWI07304D
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
RWJBarnabas
Robert Pellechio, VICE PRESIDENT, Corp Pharmacy
(973) 322-4327
Addresses
Street Address
1825 JFK BLVD
JERSEY CITY, NJ 07304
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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6/25/13 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 MEDICAID# (WAS 4139801); 5/26/09 REMOVED BILL TO (WAS 355 GRAND ST); 5/21/09 ADDED MEDICAID#; 5/22/07 MOD ENT NAME (WAS JERSEY CITY FAMILY HEALTH CENTER, INC.) AND BILL TO NAME AND ADDR (WAS JERSEY CITY FAMILY HEALTH CENTER, INC., 935 GARFIELD AVENUE); 10/19/06 ADDR CORRECTION (WAS 935 GARFIELD AVE);6/11/06 UPDATED ADDR (WAS 114 CLIFTON PLACE)
06/25/2013
8/11/10 UPDATED MEDICAID# (WAS 4139801); 5/26/09 REMOVED BILL TO (WAS 355 GRAND ST); 5/21/09 ADDED MEDICAID#; 5/22/07 MOD ENT NAME (WAS JERSEY CITY FAMILY HEALTH CENTER, INC.) AND BILL TO NAME AND ADDR (WAS JERSEY CITY FAMILY HEALTH CENTER, INC., 935 GARFIELD AVENUE); 10/19/06 ADDR CORRECTION (WAS 935 GARFIELD AVE);6/11/06 UPDATED ADDR (WAS 114 CLIFTON PLACE)
08/11/2010
May 2025
May 2025
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