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CH020710 NEWARK DEPARTMENT OF HEALTH AND HUMAN SERVICES (Active)
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Main Details
Name
NEWARK DEPARTMENT OF HEALTH AND HUMAN SERVICES
Subdivision Name
Mary Eliza Mahoney Health Center @110 William Street
Type
HRSA-Funded Health Center
Site ID
BPS-H80-002746
340B ID
CH020710
Grant Number
H80CS00009
Additional Details
Current Program Status
Active
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/1/2018
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
City of Newark
Ketlen Alsbrook, Director & CEO
(973) 733-5310
Primary Contact
Newark Department of Health and Community Wellness/Mary Eliza Mahoney Health Center
Alexandria Massey, Chief Operating Officer
(973) 877-6187
Addresses
Street Address
110 WILLIAM STREET
ROOM 208
NEWARK, NJ 07102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Last Recertification Date: 3/21/2023
03/21/2023
Participated starting 7/1/2007, terminated 4/1/2017. Reinstated 4/1/2018.
01/26/2018
9/10/07 MOD ROOM # (WAS ROOM LL105)
09/10/2007
April 2025
April 2025
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