340B Drug Pricing Program Database
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DSH310064BC ATLANTICARE REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
ATLANTICARE REGIONAL MEDICAL CENTER
Subdivision Name
MAINLAND Vascular Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310064BC
Medicare Provider Number
310064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/28/2015
Last Recertification Date
9/2/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
AtlantiCare
Hak Kim, Chief Financial Officer
(609) 569-7031
Primary Contact
AtlantiCare Regional Medical Center
Timothy Joseph Ryan, Reimbursement Manager
(609) 383-2805
Addresses
Street Address
65 W JIMMIE LEEDS ROAD
POMONA, NJ 08240-9102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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