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AVELLA OF COLUMBUS
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
AVELLA OF COLUMBUS
Pharmacy Address
4830 KNIGHTSBRIDGE BLVD STE C
COLUMBUS, OH 43214-2300
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/6/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KAREN LUMPP, CFO & SENIOR VP
(908) 994-8174
Contract Pharmacy Representative
Avella
Nancy McCutcheon, Senior Vice President, Strategic Services
(651) 983-0677
Signed By Date
7/18/2017
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