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NEW JERSEY CVS PHARMACY, L.L.C.
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
NEW JERSEY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 07182
246 NORWOOD AVE.
OAKHURST, NJ 07755
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
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