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LIVINGSTON INFUSION CARE INC
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
LIVINGSTON INFUSION CARE INC
Pharmacy Address
RWJBARNABAS HEALTH INFUSION AND SPECIALT
603 MONTROSE AVE
SOUTH PLAINFIELD, NJ 07080
Pharmacy Comments
02/22/2013 name change (was DISCOVER RX INFUSION & SPECIALTY PHARMAC); 11/15/2012 DEA update (was LIVINGSTON INFUSION PHARMACY)
Contract Details
Approval Date
10/13/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Daly, VP & CFO
(973) 972-3721
Contract Pharmacy Representative
Qualitas Pharmacy
Suzanne Sesta, Vice President
(908) 226-7450
Signed By Date
10/13/2015
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