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ANUJ RX LLC
DSH310070 SAINT PETER'S UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SAINT PETER'S UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310070
Entity Address
254 EASTON AVENUE
NEW BRUNSWICK, NJ 08901
Medicare Provider Number
310070
Participating Start Date
1/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ANUJ RX LLC
Pharmacy Address
ULTRA CARE PHARMACY
3191 STATE ROUTE 27
STORE 3
FRANKLIN PARK, NJ 08823-1356
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/18/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Garrick J. Stoldt, Chief Financial Officer
(732) 745-6651
Contract Pharmacy Representative
Ultra Care Pharmacy
Jay Patel, Owner
(908) 230-2998
Signed By Date
7/11/2019
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