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NEW JERSEY CVS PHARMACY, L.L.C.
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
NEW JERSEY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00955
430 WESTFIELD AVENUE
ELIZABETH, NJ 07208
Pharmacy Comments
Contract Details
Approval Date
10/16/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/26/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KAREN LUMPP, CFO & SENIOR VP
(908) 994-8174
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/16/2013
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