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NEW JERSEY CVS PHARMACY, L.L.C.
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
NEW JERSEY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02813
217 MAIN STREET
WEST ORANGE, NJ 07052
Pharmacy Comments
Contract Details
Approval Date
7/1/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mark P. Mercurio, AVP Finance
(976) 926-6824
Contract Pharmacy Representative
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
7/1/2014
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