Contract Pharmacy Details

NEW JERSEY CVS PHARMACY, L.L.C.
DSH310075 MONMOUTH MEDICAL CENTER

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

NEW JERSEY CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01214
470 ROUTE 36
EAST POINT PLAZA
HIGHLANDS, NJ 07732

Pharmacy Comments

Contract Details

Approval Date

4/11/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/19/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

FRANK VOZOS, CEO
(732) 923-7504

Contract Pharmacy Representative

CVS
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

4/11/2013

340B Drug Pricing Program Database