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NEW JERSEY CVS PHARMACY, L.L.C.
RWI07960 EDGE New Jersey
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Covered Entity Details
Entity Name
EDGE New Jersey
Subdivision Name
Type
Ryan White Part A
340B ID
RWI07960
Entity Address
35 WATERVIEW BLVD
Suite 201
Parsippany, NJ 07054
Grant Number
H89HA00003
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
NEW JERSEY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06872
725 STATE ROUTE 10
RANDOLPH, NJ 07869
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laurie Litt, Chief Executive Officer
(973) 285-0006 Ext: 15
Contract Pharmacy Representative
CVS
Charles Basralian, Acct Manager
(401) 772-7343
Signed By Date
7/12/2023
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