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RAINA RX LLC
DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390174
Entity Address
111 South 11th Street
Philadelphia, PA 19107
Medicare Provider Number
390174
Participating Start Date
4/1/2006
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
RAINA RX LLC
Pharmacy Address
DBA ROUTE 300 PHARMACY
1208 ROUTE 300
SUITE 103
NEWBURGH, NY 12550
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Nathans, Vice president Finance, TJUH Inc.
(215) 955-6599
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
1/12/2024
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