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WAL-MART PHARMACY 10-2003
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
WAL-MART PHARMACY 10-2003
Pharmacy Address
979 ROUTE 1 SOUTH
NORTH BRUNSWICK, NJ 08902
Pharmacy Comments
Contract Details
Approval Date
7/7/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Garrick J. Stoldt, Chief Financial Officer
(732) 745-6651
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/7/2015
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