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 # 02868
4000 ASBURY AVE.
NEPTUNE, NJ 07753

Pharmacy Comments

Contract Details

Approval Date

7/9/2014

Contract Begin Date

10/1/2014

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 Rx Services, Inc
Jordan Birnbaum, 340B Vendor Manager
(401) 770-2241

Signed By Date

7/9/2014

340B Drug Pricing Program Database