PLEASE DO NOT ALTER THIS FORM - New Jersey

State of New Jersey

Department of Banking and Insurance

Name of Managed Care Organization:

For the Period Ending:

General Acute Care Hospitals

PLEASE DO NOT ALTER THIS FORM - ANY MODIFICATION TO THIS FORM IS PROHIBITED

General Acute Care Hospitals

Contracted

Yes

No

Date Contract

Expires

Hospital

Services

ATLANTIC

AtlantiCare Regional Medical Center-City Division

AtlantiCare Regional Medical CenterMainland Division

Shore Medical Center

No OB Beds

4

1

3

5

BERGEN

Bergen New Bridge Medical Center

Englewood Hospital and Medical Center

Hackensack University Medical Center

Holy Name Medical Center

HackensackUMC At Pascack Valley

The Valley Hospital

No OB Beds

1

RPC, CH

1

3

2

3

5

4

5

5

1

3

5

BURLINGTON

Virtua Marlton Hospital

Virtua Memorial Hospital

Virtua Willingboro Hospital

No OB Beds

5

5

No OB Beds

CAMDEN

Cooper Hospital/University Medical Center

Jefferson Cherry Hill Hospital

Jefferson Stratford Hospital

Virtua Our Lady of Lourdes Hospital

Virtua Voorhees Hospital

RPC, CH

1

2

1

1

2

3

4

5

No OB Beds

No OB Beds

RPC

RPC

3

5

CAPE MAY

Cape Regional Medical Center

No OB Beds

CUMBERLAND

Inspira Medical Center Vineland

1

ESSEX

Clara Maass Medical Center

Cooperman Barnabas Medical Center

CareWell Health Medical Center

HackensackUMC Mountainside Hospital

Newark Beth Israel Medical Center

Saint Michael's Medical Center

University Hospital

5

RPC

1

2

3

5

1

2

3

5

2

3

3

5

5

No OB Beds

5

RPC, CH

No OB Beds

RPC

1

Report hospitals with a written executed contract with the Plan. All other arrangements must be reported under comments.

1. NJDHSS licensed Neonatal Intensive Care Unit (NICU) Bassinets

2. NJDHSS licensed Pediatric Intensive Care Unit (PICU) beds

3. NJDHSS designated Cardiac Surgery

4. NJDHSS designated Level l or II Trauma Center

5. NJDHSS designated Primary Angioplasty Site

(RPC) - NJDHSS licensed Regional Perinatal Center

(CH) - NJDHSS licensed Children's Hospital

rev. 4/26/23

4

Name of Managed Care Organization:

For the Period Ending:

General Acute Care Hospitals

PLEASE DO NOT ALTER THIS FORM - ANY MODIFICATION TO THIS FORM IS PROHIBITED

General Acute Care Hospitals

Contracted

Yes

No

Hospital

Services

Date Contract

Expires

GLOUCESTER

Inspira Medical Center Mullica Hill

Jefferson Washington Township Hospital

5

1

HUDSON

CarePoint Health-Bayonne Medical Center

CarePoint Health-Christ Hospital

CarePoint Health-Hoboken University Medical Center

Hudson Regional Hospital

Jersey City Medical Center

Palisades Medical Center

5

5

RPC

1

3

4

5

HUNTERDON

Hunterdon Medical Center

5

MERCER

Capital Health Regional Medical Center

Capital Health Medical Center - Hopewell

RWJ University Hospital at Hamilton

No OB Beds

RPC

3

4

1

5

5

No OB Beds

MIDDLESEX

Raritan Bay Medical Center-Old Bridge

Raritan Bay Medical Center - Perth Amboy

JFK Medical Center

RWJ University Hospital at New Brunswick

Penn Medicine Princeton Medical Center

Saint Peter's University Hospital

No OB Beds

5

5

RPC, CH

1

2

CH, RPC

1

2

RPC, CH

1

2

RPC, CH

1

2

3

4

5

5

5

MONMOUTH

Bayshore Community Hospital

CentraState Medical Center

Jersey Shore University Medical Center

Monmouth Medical Center

Riverview Medical Center

No OB Beds

3

4

5

5

5

MORRIS

Chilton Medical Center

Morristown Medical Center

St. Clare's Hospital - Dover

St. Clare's Hospital - Denville

5

RPC, CH

1

2

3

4

5

No OB Beds

5

OCEAN

Community Medical Center

Monmouth Medical Center - Southern Campus

Ocean Medical Center - Brick

Southern Ocean Medical Center

5

No OB Beds

Report hospitals with a written executed contract with the Plan. All other arrangements must be reported under comments.

1. NJDHSS licensed Neonatal Intensive Care Unit (NICU) Bassinets

2. NJDHSS licensed Pediatric Intensive Care Unit (PICU) beds

3. NJDHSS designated Cardiac Surgery

4. NJDHSS designated Level l or II Trauma Center

5. NJDHSS designated Primary Angioplasty Site

(RPC) - NJDHSS licensed Regional Perinatal Center

(CH) - NJDHSS licensed Children's Hospital

5

State of New Jersey

Department of Banking and Insurance

Name of Managed Care Organization:

For the Period Ending:

General Acute Care Hospitals

PLEASE DO NOT ALTER THIS FORM - ANY MODIFICATION TO THIS FORM IS PROHIBITED

General Acute Care Hospitals

Contracted

Yes

No

Date Contract

Expires

Hospital

Services

PASSAIC

St. Joseph's University Medical Center

St. Joseph's Wayne Medical Center

St. Mary's General Hospital

RPC, CH

1

2

3

4

5

No OB Beds

3

5

SALEM

Inspira Medical Center Elmer

Salem Medical Center

No OB Beds

SOMERSET

RWJ University Hospital at Somerset

5

SUSSEX

Newton Medical Center

UNION

Overlook Medical Center

RWJ University Hospital at Rahway

Trinitas Regional Medical Center

1

No OB Beds

WARREN

Hackettstown Regional Medical Center

St. Luke's Warren Hospital

No OB Beds

No OB Beds

Report hospitals with a written executed contract with the Plan. All other arrangements must be reported under comments.

1. NJDHSS licensed Neonatal Intensive Care Unit (NICU) Bassinets

2. NJDHSS licensed Pediatric Intensive Care Unit (PICU) beds

3. NJDHSS designated Cardiac Surgery

4. NJDHSS designated Level l or II Trauma Center

5. NJDHSS designated Primary Angioplasty Site

(RPC) - NJDHSS licensed Regional Perinatal Center

(CH) - NJDHSS licensed Children's Hospital

5

5

5

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