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FLORIDA DRUG AND LIQUOR
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
FLORIDA DRUG AND LIQUOR
Pharmacy Address
507 BROADWAY
PATERSON, NJ 07514
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Slavin, President and CEO
(973) 754-2002 Ext: 9737542010
Contract Pharmacy Representative
Rushin Inc
Pradip Acharya, President
(973) 925-7200
Signed By Date
7/15/2020
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