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BELL PHARMACY
RWI08901 Hyacinth Foundation
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Covered Entity Details
Entity Name
Hyacinth Foundation
Subdivision Name
New Brunswick
Type
Ryan White Part A
340B ID
RWI08901
Entity Address
317 George Street
Suite 203
New Brunswick, NJ 08901
Grant Number
H89HA00049
Participating Start Date
1/1/2014
Last Recertification Date
2/13/2017
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
BELL PHARMACY
Pharmacy Address
1907 STATE ROUTE 27
EDISON, NJ 08817
Pharmacy Comments
Contract Details
Approval Date
7/3/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
Kathy Ahearn-O'Brien, Executive Director
(732) 246-0204
Contract Pharmacy Representative
George Rusuloj, Pharmacist
(732) 985-1211
Signed By Date
7/3/2014
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