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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
SIDDHI GANESHA INC
655 E JERSEY ST
ELIZABETH, NJ 07206-1259
Pharmacy Comments
Contract Details
Approval Date
4/12/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark P. Nessel, COO
(856) 580-6333
Contract Pharmacy Representative
Bergen Pharmacy
Devang Nagrecha, President
(908) 994-9700
Signed By Date
4/12/2021
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