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THE STOP & SHOP SUPERMARKET COMPANY LLC
DSH310070 SAINT PETER'S UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SAINT PETER'S UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310070
Entity Address
254 EASTON AVENUE
NEW BRUNSWICK, NJ 08901
Medicare Provider Number
310070
Participating Start Date
1/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
THE STOP & SHOP SUPERMARKET COMPANY LLC
Pharmacy Address
DBA STOP & SHOP PHARMACY #2809
647 ROUTE 18 SOUTH
EAST BRUNSWICK, NJ 08816
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Garrick J. Stoldt, Chief Financial Officer
(732) 745-6651
Contract Pharmacy Representative
Stop and Shop
Katie Thornell, Director of Pharmacy
(978) 712-8325
Signed By Date
7/15/2021
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