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LIVINGSTON INFUSION CARE INC
DSH310084 Monmouth Medical Center Southern Campus
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Covered Entity Details
Entity Name
Monmouth Medical Center Southern Campus
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310084
Entity Address
600 RIVER AVE
LAKEWOOD, NJ 08701
Medicare Provider Number
310084
Participating Start Date
1/1/2015
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
LIVINGSTON INFUSION CARE INC
Pharmacy Address
RWJBARNABAS HEALTH INFUSION AND SPECIALT
603 MONTROSE AVE
SOUTH PLAINFIELD, NJ 07080
Pharmacy Comments
02/22/2013 name change (was DISCOVER RX INFUSION & SPECIALTY PHARMAC); 11/15/2012 DEA update (was LIVINGSTON INFUSION PHARMACY)
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joanna Zimmerman, Chief Financial Officer
(732) 923-7181
Contract Pharmacy Representative
Qualitas Pharmacy
Suzanne Sesta, Vice President
(908) 226-7450
Signed By Date
10/16/2018
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