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UNION AVENUE LEGEND PHARMACY
CH027000 Central Jersey Medical Center Inc.
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Covered Entity Details
Entity Name
Central Jersey Medical Center Inc.
Subdivision Name
Central Jersey Medical Center Inc.
Type
HRSA-Funded Health Center
340B ID
CH027000
Entity Address
275 Hobart St
Perth Amboy, NJ 08861-4310
Grant Number
H80CS00253
Participating Start Date
1/1/2005
Last Recertification Date
3/1/2025
Pharmacy Details
Pharmacy Name
UNION AVENUE LEGEND PHARMACY
Pharmacy Address
UNION AVENUE PHARMACY
433 WEST UNION AVE
BOUND BROOK, NJ 08805
Pharmacy Comments
Contract Details
Approval Date
4/21/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/13/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Osner Louissaint, Controller
(732) 376-6612
Contract Pharmacy Representative
Jay Patel, Owner
(732) 356-2159
Signed By Date
4/21/2017
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