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BERGEN PHARMACY
DSH310119 UH - UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
UH - UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310119
Entity Address
150 BERGEN ST
NEWARK, NJ 07103
Medicare Provider Number
310119
Participating Start Date
1/1/1999
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
BERGEN PHARMACY
Pharmacy Address
90 BERGEN ST STE 1600
NEWARK, NJ 07103
Pharmacy Comments
Contract Details
Approval Date
1/8/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Daly, VP & CFO
(973) 972-3721
Contract Pharmacy Representative
Bergen
Abhijeet Jatania, Pharmacist in Charge
(973) 972-1960
Signed By Date
1/8/2015
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