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HACKENSACK MERIDIAN HEALTH PHARMACY
RWI08861 Early Intervention Program
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Covered Entity Details
Entity Name
Early Intervention Program
Subdivision Name
Type
Ryan White Part A
340B ID
RWI08861
Entity Address
500 Lawrie Street
Perth Amboy, NJ 08861
Grant Number
H89HA00049-29-02
Participating Start Date
1/1/2025
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
HACKENSACK MERIDIAN HEALTH PHARMACY
Pharmacy Address
34 INDUSTRIAL WAY E STE 4
EATONTOWN, NJ 07724-3319
Pharmacy Comments
Contract Details
Approval Date
1/6/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
karyn berk, registered nurse
(732) 324-5022
Contract Pharmacy Representative
Hackensack Meridian Health
Audra Manekas, Director of Specialty Pharmacy
(732) 836-4401
Signed By Date
1/6/2025
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