Contract Pharmacy Details

COORDINATED CARE NETWORK PHARMACY
FP07103 Rutgers, The State University of New Jersey

Covered Entity Details

Entity Name

Rutgers, The State University of New Jersey

Subdivision Name

RBHS-NJMS Department of Pediatrics Division of Adolescent and Young Adult Medicine

Type

Family Planning (Title X only)

340B ID

FP07103

Entity Address

90 Bergen Street
Suite 4400
Newark, NJ 07103

Grant Number

FPHPA006527-04

Participating Start Date

1/1/2019

Last Recertification Date

5/7/2025

Pharmacy Details

Pharmacy Name

COORDINATED CARE NETWORK PHARMACY

Pharmacy Address

268 MARTIN LUTHER KING JR. BLVD.
NEWARK, NJ 07102

Pharmacy Comments

Contract Details

Approval Date

12/18/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Diane M Ambrose, Director, Office of Research and Sponsored Programs
(848) 932-4037

Contract Pharmacy Representative

Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300

Signed By Date

12/18/2018

340B Drug Pricing Program Database