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SHEEFA PHARMACY #3
DSH310019 St. Joseph’s University Medical Center
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Covered Entity Details
Entity Name
St. Joseph’s University Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310019
Entity Address
703 MAIN STREET
PATERSON, NJ 07503
Medicare Provider Number
310019
Participating Start Date
10/1/2002
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
SHEEFA PHARMACY #3
Pharmacy Address
AJIMI INC
472 CLIFTON AVE
CLIFTON, NJ 07011-0701
Pharmacy Comments
Contract Details
Approval Date
4/8/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/21/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William McDonald, President and CEO
(973) 754-2002
Contract Pharmacy Representative
Susan Anderson, Store Manager
(973) 772-7600
Signed By Date
4/8/2013
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