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J AND J STATE STREET PHARMACY
STD07103 North Jersey AIDS Alliance, Inc d.b.a. North Jersey Community Research Initiative (NJCRI)
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Covered Entity Details
Entity Name
North Jersey AIDS Alliance, Inc d.b.a. North Jersey Community Research Initiative (NJCRI)
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD07103
Entity Address
393 Central Ave
Newark, NJ 07103
Grant Number
NU62PS924524
Participating Start Date
10/1/2016
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
J AND J STATE STREET PHARMACY
Pharmacy Address
298 STATE STREET
HACKENSACK, NJ 07601
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/10/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Brian McGovern, CEO
(973) 849-0084
Contract Pharmacy Representative
J and J State Street Pharmacy
James DeMicco, Pharmacist
(201) 820-3360
Signed By Date
1/12/2018
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