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LSC MAIL ORDER PHARMACY
DSH310002 NEWARK BETH ISRAEL MEDICAL CENTER
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Covered Entity Details
Entity Name
NEWARK BETH ISRAEL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310002
Entity Address
201 LYONS AVENUE
NEWARK, NJ 07112
Medicare Provider Number
310002
Participating Start Date
10/1/2004
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
LSC MAIL ORDER PHARMACY
Pharmacy Address
605 MONTROSE AVE
SOUTH PLAINFIELD, NJ 07080
Pharmacy Comments
Contract Details
Approval Date
10/25/2011
Contract Begin Date
10/25/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
FRANK VOZOS, CEO
(732) 923-7504
Contract Pharmacy Representative
Qualitas Pharmacy
Suzanne Sesta, Vice President
(908) 226-7450
Signed By Date
11/1/2011
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