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NEW JERSEY CVS PHARMACY, L.L.C.
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
NEW JERSEY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00761
560 PASSIAC AVE
WEST CALDWELL S/C
WEST CALDWELL, NJ 07006
Pharmacy Comments
Contract Details
Approval Date
7/3/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/19/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Ellen Clyne, CEO
(973) 450-2002
Contract Pharmacy Representative
CVS Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241
Signed By Date
7/3/2014
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