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BERGEN PHARMACY
DSH310027 TRINITAS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TRINITAS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310027
Entity Address
225 WILLIAMSON ST
ELIZABETH, NJ 07202
Medicare Provider Number
310027
Participating Start Date
1/1/2005
Last Recertification Date
9/1/2024
Pharmacy Details
Pharmacy Name
BERGEN PHARMACY
Pharmacy Address
SIDDHI GANESHA INC
655 E JERSEY ST
ELIZABETH, NJ 07206-1259
Pharmacy Comments
Contract Details
Approval Date
7/9/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nancy DiLiegro, Vice President of Clinical Operations and Physician Services, Chief Clinical Officer
(908) 994-5226
Contract Pharmacy Representative
Bergen Pharmacy
Devang Nagrecha, President
(908) 994-9700
Signed By Date
7/9/2018
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