340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
GOETHALS PHARMACY
DSH310027 TRINITAS REGIONAL MEDICAL CENTER
Print
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
GOETHALS PHARMACY
Pharmacy Address
GOETHALS PHARMACY
638 BAYWAY AVE
ELIZABETH, NJ 07202
Pharmacy Comments
Contract Details
Approval Date
3/13/2013
Contract Begin Date
4/1/2013
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
KAREN LUMPP, CFO & SENIOR VP
(908) 994-8071
Contract Pharmacy Representative
Prabodh Ajbani, President
(908) 527-1112
Signed By Date
1/28/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session