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LSC MAIL ORDER PHARMACY
DSH310038 ROBERT WOOD JOHNSON UNIVERSITY HOSP
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Covered Entity Details
Entity Name
ROBERT WOOD JOHNSON UNIVERSITY HOSP
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310038
Entity Address
ONE ROBERT WOOD JOHNSON PLACE
NEW BRUNSWICK, NJ 08901-2601
Medicare Provider Number
310038
Participating Start Date
7/1/2015
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
LSC MAIL ORDER PHARMACY
Pharmacy Address
605 MONTROSE AVE
SOUTH PLAINFIELD, NJ 07080
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Kenneth M. Wright, VP of Finance & Chief Financial Officer
(732) 418-8410
Contract Pharmacy Representative
Qualitas Pharmacy
Suzanne Sesta, Vice President
(908) 226-7450
Signed By Date
10/13/2016
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