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RITE AID NEW JERSEY, INC.
DSH310021 St Francis Medical Center
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Covered Entity Details
Entity Name
St Francis Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310021
Entity Address
601 Hamilton Ave
Trenton, NJ 08629
Medicare Provider Number
310021
Participating Start Date
4/1/2014
Last Recertification Date
8/25/2022
Entity Termination Date
1/1/2023
Pharmacy Details
Pharmacy Name
RITE AID NEW JERSEY, INC.
Pharmacy Address
RITE AID #3324
1091 SOUTH BROAD STREET
TRENTON, NJ 08611
Pharmacy Comments
Contract Details
Approval Date
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Mark Kelly, VP Finance/CFO
(609) 599-5119 Ext: 5119
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/8/2018
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