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RITE AID NEW JERSEY, INC.
DSH310009 CLARA MAASS MEDICAL CENTER
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Covered Entity Details
Entity Name
CLARA MAASS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310009
Entity Address
ONE CLARA MAASS DRIVE
BELLEVILLE, NJ 07109-3550
Medicare Provider Number
310009
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
RITE AID NEW JERSEY, INC.
Pharmacy Address
RITE AID #1618
100 FRANKLIN AVENUE
NUTLEY, NJ 07110
Pharmacy Comments
Contract Details
Approval Date
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/10/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Ellen Clyne, CEO
(973) 450-2002
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/16/2014
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