Contract Pharmacy Details

MEDLY PHARMACY
CHC29013-00 JEWISH RENAISSANCE FOUNDATION INC., THE

Covered Entity Details

Entity Name

JEWISH RENAISSANCE FOUNDATION INC., THE

Subdivision Name

The Jewish Renaissance Community Health Center

Type

HRSA-Funded Health Center

340B ID

CHC29013-00

Entity Address

1931 Oak Tree Road
Edison, NJ 08820

Grant Number

H80CS29013

Participating Start Date

4/1/2017

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

MEDLY PHARMACY

Pharmacy Address

40 W MAIN ST
SOMERVILLE, NJ 08876

Pharmacy Comments

Contract Details

Approval Date

1/10/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/12/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Peter R. Velez, Chief Operating Officer
(732) 482-9600 Ext: 102

Contract Pharmacy Representative

Medly Pharmacy
Jitendra Patel, Pharmacy Director
(718) 782-7539

Signed By Date

1/10/2020

340B Drug Pricing Program Database