340B Drug Pricing Program Database
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DSH310084D Monmouth Medical Center Southern Campus (Terminated)
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Main Details
Name
Monmouth Medical Center Southern Campus
Subdivision Name
Jacqueline M. Wilentz Breast Center / Bone Mineral Density Study, Ultrasound
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310084D
Medicare Provider Number
310084
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/20/2015
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
4/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
RWJBarnabas Health
Nikolas Alexiades, CFO
(973) 926-7824
Primary Contact
RWJBarnabas
Robert Pellechio, VICE PRESIDENT, Corp Pharmacy
(973) 322-4327
Addresses
Street Address
500 River Ave, Suite 200
Lakewood, NJ 08701
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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