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LSC MAIL ORDER PHARMACY
DSH310076 SAINT BARNABAS MEDICAL CENTER
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Covered Entity Details
Entity Name
SAINT BARNABAS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH310076
Entity Address
94 OLD SHORT HILLS RD
LIVINGSTON, NJ 07039-5668
Medicare Provider Number
310076
Participating Start Date
1/1/2017
Last Recertification Date
11/20/2017
Entity Termination Date
7/1/2018
Pharmacy Details
Pharmacy Name
LSC MAIL ORDER PHARMACY
Pharmacy Address
605 MONTROSE AVE
SOUTH PLAINFIELD, NJ 07080
Pharmacy Comments
Contract Details
Approval Date
10/11/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Richard Davis, Chief Financial Officer
(973) 322-5612
Contract Pharmacy Representative
Qualitas Pharmacy
Suzanne Sesta, Vice President
(908) 226-7450
Signed By Date
10/11/2016
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