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BIOLOGICTX, LLC
RWI07960 EDGE New Jersey
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Covered Entity Details
Entity Name
EDGE New Jersey
Subdivision Name
Type
Ryan White Part A
340B ID
RWI07960
Entity Address
35 WATERVIEW BLVD
Suite 201
Parsippany, NJ 07054
Grant Number
H89HA00003
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
BIOLOGICTX, LLC
Pharmacy Address
BIOMATRIX SPECIALTY PHARMACY NJ
40D COMMERCE WAY
TOTOWA, NJ 07512-3109
Pharmacy Comments
Contract Details
Approval Date
4/13/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Laurie Litt, Chief Executive Officer
(973) 285-0006 Ext: 15
Contract Pharmacy Representative
BioMatrix
Sal Rafanelli, EVP
(877) 567-8087 Ext: 808
Signed By Date
4/13/2019
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