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PERFORMSPECIALTY, LLC
DSH310086 KENNEDY MEMORIAL HOSPITAL-UMC
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Covered Entity Details
Entity Name
KENNEDY MEMORIAL HOSPITAL-UMC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310086
Entity Address
18 East Laurel Road
Stratford, NJ 08084
Medicare Provider Number
310086
Participating Start Date
4/1/2016
Last Recertification Date
9/4/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
PERFORMSPECIALTY, LLC
Pharmacy Address
2416 LAKE ORANGE DR.
STE 190
ORLANDO, FL 32837
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
10/24/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stephen V DeStefano, Vice President Finance
(215) 587-3332
Contract Pharmacy Representative
Perform Specialty
Shavonda Leakes, Director of Pharmacy Operations
(407) 581-9869
Signed By Date
10/14/2022
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