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RIVER MEDICAL PHARMACY LLC
DSH390115 Jefferson Health Northeast
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Covered Entity Details
Entity Name
Jefferson Health Northeast
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390115
Entity Address
10800 Knights Rd.
PHILADELPHIA, PA 19114
Medicare Provider Number
390115
Participating Start Date
10/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
RIVER MEDICAL PHARMACY LLC
Pharmacy Address
4752 RESEARCH DR
SAN ANTONIO, TX 78240-5002
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CARRIE FREY, Director of Finance
(215) 612-4313
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
1/11/2024
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