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MT PROS PHARM SERVICES INC
STD071033 Rutgers, The State University of New Jersey
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Covered Entity Details
Entity Name
Rutgers, The State University of New Jersey
Subdivision Name
RBHS - New Jersey Medical School
Type
Sexually Transmitted Diseases
340B ID
STD071033
Entity Address
140 Bergen Street
ACC, D-Level, Room D1725
NewarK, NJ 07103-0000
Grant Number
NH25PS005174-06
Participating Start Date
10/1/2019
Last Recertification Date
5/9/2024
Pharmacy Details
Pharmacy Name
MT PROS PHARM SERVICES INC
Pharmacy Address
T/A LISS PHARMACY
794 MOUNT PROSPECT AVE
NEWARK, NJ 07104-3221
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Letitia Dean, Assistant Director, Office of Research and Sponsored Programs
(973) 972-0283
Contract Pharmacy Representative
Liss Pharmacy
Richard Mistichelli, Pharmacist
(973) 483-4749
Signed By Date
4/14/2021
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