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LIVINGSTON INFUSION CARE INC
DSH310075 MONMOUTH MEDICAL CENTER
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Covered Entity Details
Entity Name
MONMOUTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310075
Entity Address
300 SECOND AVENUE
LONG BRANCH, NJ 07740
Medicare Provider Number
310075
Participating Start Date
10/1/2004
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
LIVINGSTON INFUSION CARE INC
Pharmacy Address
RWJBARNABAS HEALTH INFUSION AND SPECIALT
603 MONTROSE AVE
SOUTH PLAINFIELD, NJ 07080
Pharmacy Comments
02/22/2013 name change (was DISCOVER RX INFUSION & SPECIALTY PHARMAC); 11/15/2012 DEA update (was LIVINGSTON INFUSION PHARMACY)
Contract Details
Approval Date
11/15/2012
Contract Begin Date
10/26/2012
Carve-In Effective Date
Contract Comments
11/14/2012 - public health emergency declared in the state of NJ effective 10/26/2012
Contacts
Covered Entity Signing Official
FRANK VOZOS, CEO
(732) 923-7504
Contract Pharmacy Representative
Suzanne Sesta, Vice President
(908) 851-7420
Signed By Date
10/1/2012
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