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EXPRESS SCRIPTS PHARMACY, INC.
DSH310074 JERSEY CITY MEDICAL CENTER
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Covered Entity Details
Entity Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310074
Entity Address
355 GRAND STREET
JERSEY CITY, NJ 07302
Medicare Provider Number
310074
Participating Start Date
4/1/1997
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
EXPRESS SCRIPTS PHARMACY, INC.
Pharmacy Address
DBA EXPRESS SCRIPTS
4750 E. 450 S.
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Domenic Segalla, CFO
(201) 521-5926
Contract Pharmacy Representative
Accredo Health Group
Gene McCabe, 340B Sales Director
(615) 943-7500
Signed By Date
7/15/2016
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