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RITE AID OF NEW JERSEY, INC.
DSH310019 St. Joseph’s University Medical Center
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Covered Entity Details
Entity Name
St. Joseph’s University Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310019
Entity Address
703 MAIN STREET
PATERSON, NJ 07503
Medicare Provider Number
310019
Participating Start Date
10/1/2002
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
RITE AID OF NEW JERSEY, INC.
Pharmacy Address
RITE AID #1736
RICHFIELD SHOPPING CENTER
1366 CLIFTON AVE
CLIFTON, NJ 07012
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Slavin, President and CEO
(973) 754-2002 Ext: 9737542010
Contract Pharmacy Representative
Rite Aid
Lisa Foster, Manager-Pharmacy
(717) 214-2518
Signed By Date
10/10/2019
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