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NEW JERSEY CVS PHARMACY, L.L.C.
DSH310070 SAINT PETER'S UNIVERSITY HOSPITAL
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Covered Entity Details
Entity Name
SAINT PETER'S UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310070
Entity Address
254 EASTON AVENUE
NEW BRUNSWICK, NJ 08901
Medicare Provider Number
310070
Participating Start Date
1/1/2014
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
NEW JERSEY CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02139
2988 ROUTE 516
OLD BRIDGE, NJ 08857
Pharmacy Comments
Contract Details
Approval Date
1/20/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Garrick J. Stoldt, Chief Financial Officer
(732) 745-6651
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
1/20/2014
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