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EAST ORANGE PHARMACY
RWI07103 North Jersey AIDS Alliance dba North Jersey Community Research Initiative (NJCRI)
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Covered Entity Details
Entity Name
North Jersey AIDS Alliance dba North Jersey Community Research Initiative (NJCRI)
Subdivision Name
Type
Ryan White Part A
340B ID
RWI07103
Entity Address
393 Central Avenue
Newark, NJ 07103
Grant Number
H89HA00003
Participating Start Date
7/1/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
EAST ORANGE PHARMACY
Pharmacy Address
EVERGREEN LLC
60 EVERGREEN PL STE 104
EAST ORANGE, NJ 07018-2114
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
12/6/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian McGovern, CEO
(973) 849-0084
Contract Pharmacy Representative
East Orange Pharmacy
Amit Datwani, Partner
(973) 674-5777
Signed By Date
10/14/2021
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