340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH310096 ST. MICHAEL'S MEDICAL CENTER, INC. (Terminated)
Print
Main Details
Name
ST. MICHAEL'S MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310096
Medicare Provider Number
310096
Additional Details
Current Program Status
Terminated
Registration Date
7/25/2008
Participating Start Date
10/1/2004
Participating Approval Date
7/25/2008
Last Recertification Date
8/5/2015
Termination Date
Termination Reason
7/1/2016
For-Profit conversion
Contacts
Authorizing Official
Dennis Pettigrew, CFO/COO
(973) 854-3523
Primary Contact
Maria Barbosa, Executive Assistant
(973) 854-3588
Addresses
Street Address
111 CENTRAL AVENUE
NEWARK, NJ 07102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
7/25/08 ADDR MOD (WAS 268 DR MARTIN LUTHER KING JR BLVD)
07/25/2008
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session