Contract Pharmacy Details

NEW JERSEY CVS PHARMACY, L.L.C.
DSH310019 St. Joseph’s University Medical Center

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

NEW JERSEY CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02093
18-35 RIVER ROAD
FAIR LAWN, NJ 07410

Pharmacy Comments

Contract Details

Approval Date

7/9/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

William McDonald, President and CEO
(973) 754-2002

Contract Pharmacy Representative

CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298

Signed By Date

7/9/2013

340B Drug Pricing Program Database