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BERGEN PHARMACY
DSH310029 Virtua Our Lady Of Lourdes Hospital
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Covered Entity Details
Entity Name
Virtua Our Lady Of Lourdes Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310029
Entity Address
1600 HADDON AVENUE
CAMDEN, NJ 08103
Medicare Provider Number
310029
Participating Start Date
7/1/2009
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
BERGEN PHARMACY
Pharmacy Address
90 BERGEN ST STE 1600
NEWARK, NJ 07103
Pharmacy Comments
Contract Details
Approval Date
7/1/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark P. Nessel, COO
(856) 580-6333
Contract Pharmacy Representative
Bergen
Abhijeet Jatania, Pharmacist in Charge
(973) 972-1960
Signed By Date
7/1/2020
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