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PREMIER HEALTH PHARMACY
RWI07103 North Jersey AIDS Alliance dba North Jersey Community Research Initiative (NJCRI)
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Covered Entity Details
Entity Name
North Jersey AIDS Alliance dba North Jersey Community Research Initiative (NJCRI)
Subdivision Name
Type
Ryan White Part A
340B ID
RWI07103
Entity Address
393 Central Avenue
Newark, NJ 07103
Grant Number
H89HA00003
Participating Start Date
7/1/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
PREMIER HEALTH PHARMACY
Pharmacy Address
393 CENTRAL AVE
NEWARK, NJ 07103
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Brian McGovern, CEO
(973) 849-0084
Contract Pharmacy Representative
Barry's Montville Pharmacy
Amit Patel, Owner
(908) 420-5524
Signed By Date
10/11/2019
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