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WAL-MART PHARMACY 10-2633
DSH310027 TRINITAS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TRINITAS REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310027
Entity Address
225 WILLIAMSON ST
ELIZABETH, NJ 07202
Medicare Provider Number
310027
Participating Start Date
1/1/2005
Last Recertification Date
9/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2633
Pharmacy Address
1303 CENTENNIAL AVENUE
PISCATAWAY, NJ 08854
Pharmacy Comments
Contract Details
Approval Date
1/18/2012
Contract Begin Date
1/18/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sharon Greasheimer, DIRECTOR OF PHARMACY
(908) 994-5238
Contract Pharmacy Representative
Wal--Mart
Marcus Osborne, Sales & Contracting
(479) 204-8452
Signed By Date
12/16/2011
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