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RWI07306 JERSEY CITY MEDICAL CENTER (Terminated)
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Main Details
Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
DENTAL CLINIC
Type
Ryan White Part A
340B ID
RWI07306
Grant Number
H89HA00003
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/12/2013
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
418 SUMMIT AVENUE
JERSEY CITY, NJ 07306
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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