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BARNABAS HEALTH RETAIL PHARMACY
DSH310074A JERSEY CITY MEDICAL CENTER
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Covered Entity Details
Entity Name
JERSEY CITY MEDICAL CENTER
Subdivision Name
OUTPATIENT PSYCHIATRY CLINICS
Type
Disproportionate Share Hospital
340B ID
DSH310074A
Entity Address
395 GRAND STREET
JERSEY CITY, NJ 07302
Medicare Provider Number
310074
Outpatient Facility Provider Number
Participating Start Date
1/1/2005
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
BARNABAS HEALTH RETAIL PHARMACY
Pharmacy Address
BARNABAS HEALTH RETAIL PHARMACY
355 GRAND ST
JERSEY CITY, NJ 07302
Pharmacy Comments
Contract Details
Approval Date
1/10/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOSEPH F. SCOTT, PRESIDENT & CEO
(201) 521-5925
Contract Pharmacy Representative
Kenneth Markakis, pharmacist-in-charge
(201) 915-2166
Signed By Date
1/10/2014
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