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COORDINATED CARE NETWORK PHARMACY
RWI07101A Rutgers, The State University of New Jersey
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Covered Entity Details
Entity Name
Rutgers, The State University of New Jersey
Subdivision Name
RBHS-NJMS Department of Pediatrics Division of Adolescent and Young Adult Medicine
Type
Ryan White Part A
340B ID
RWI07101A
Entity Address
90 Bergen Street
Suite 4400
Newark, NJ 07103-2403
Grant Number
H89HA00003
Participating Start Date
7/1/2017
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
COORDINATED CARE NETWORK PHARMACY
Pharmacy Address
268 MARTIN LUTHER KING JR. BLVD.
NEWARK, NJ 07102
Pharmacy Comments
Contract Details
Approval Date
10/6/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelley Rooney, Administrator
(973) 972-6198
Contract Pharmacy Representative
Coordinated Care Network
Thomas J Pollack, President/CEO
(412) 349-6300
Signed By Date
10/6/2017
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