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EAST ORANGE PHARMACY
STD07103 North Jersey AIDS Alliance, Inc d.b.a. North Jersey Community Research Initiative (NJCRI)
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Covered Entity Details
Entity Name
North Jersey AIDS Alliance, Inc d.b.a. North Jersey Community Research Initiative (NJCRI)
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD07103
Entity Address
393 Central Ave
Newark, NJ 07103
Grant Number
NU62PS924524
Participating Start Date
10/1/2016
Last Recertification Date
5/14/2024
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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