| Details | Last Recertification Date | Update | Recertification | 8/20/2023 9:35:33 AM | 8/18/2024 11:13:13 AM | 8/18/2024 11:13 AM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2022 10:10:06 AM | 8/20/2023 9:35:33 AM | 8/20/2023 9:35 AM |
| Details | Last Recertification Date | Update | Recertification | 9/13/2021 10:04:46 AM | 8/26/2022 10:10:06 AM | 8/26/2022 10:10 AM |
| Addresses | Shipping Address | Delete | Recertification | Highland Hospital (CSC)
155 Bellwood Drive
Rochester, NY 14606 | | 9/13/2021 10:04 AM |
| Addresses | Shipping Address | Insert | Recertification | | Strong Memorial Hospital - Consolidated Services Center
155 Bellwood Drive
Rochester, NY 14606 | 9/13/2021 10:04 AM |
| Details | Last Recertification Date | Update | Recertification | 9/7/2020 11:10:06 AM | 9/13/2021 10:04:46 AM | 9/13/2021 10:04 AM |
| Contacts | Primary Contact | Update | Change Request | Lees, Katy
Director, 340B Policy and Business Strategy
UR Medicine
5857035169 | Lees, Katy
Director, 340B Policy and Business Strategy
UR Medicine
5857035169-5855964002 | 12/10/2020 8:06 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1740220698 | 9/7/2020 11:10 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NY | 9/7/2020 11:10 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1972548568 | 9/7/2020 11:10 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NY | 9/7/2020 11:10 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1740220698 ( ) | | 9/7/2020 11:10 AM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2019 11:00:44 AM | 9/7/2020 11:10:06 AM | 9/7/2020 11:10 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Lees, Katy
Director, 340B Policy and Business Strategy
UR Medicine
5857855154 | Lees, Katy
Director, 340B Policy and Business Strategy
UR Medicine
5857035169 | 9/3/2020 12:10 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Lees, Katy
Associate Director of Pharmacy, 340B Policy and Business Strategy
UR Medicine
5857855154 | Lees, Katy
Director, 340B Policy and Business Strategy
UR Medicine
5857855154 | 8/21/2020 9:29 AM |
| Contacts | Primary Contact | Update | Profile Change Request | Lees, Katy
340B Business Manager
UR Medicine
5857855154 | Lees, Katy
Associate Director of Pharmacy, 340B Policy and Business Strategy
UR Medicine
5857855154 | 10/28/2019 11:14 AM |
| Addresses | Shipping Address | Insert | Change Request | | Highland Hospital (CSC)
155 Bellwood Drive
Rochester, NY 14606 | 9/13/2019 7:35 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Fuller Spencer, Carrie
Chief Financial Officer
Strong Memorial Hospital
5852753033 | Fuller Spencer, Carrie
Chief Financial Officer
Strong Memorial Hospital & Highland Hospital
5852753033 | 9/11/2019 10:34 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2018 9:16:31 AM | 9/6/2019 11:00:44 AM | 9/6/2019 11:00 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Fuller-Spencer, Carrie
Chief Financial Officer
Strong Memorial Hospital
5852753033 | Fuller Spencer, Carrie
Chief Financial Officer
Strong Memorial Hospital
5852753033 | 9/6/2019 10:41 AM |
| Contacts | Authorizing Official | Update | Profile Change Request | Fuller-Spencer, Carrie
Senior Director of Financial Services
Strong Memorial Hospital
5852753033 | Fuller-Spencer, Carrie
Chief Financial Officer
Strong Memorial Hospital
5852753033 | 9/6/2019 10:41 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 5/10/2019 12:42 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 02959915 | 5/10/2019 12:42 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | NY | 5/10/2019 12:42 PM |
| Contacts | Authorizing Official | Update | Change Request | Segerson, Kevin
Director of Finance
Highland Hospital
5853416686 | Fuller-Spencer, Carrie
Senior Director of Financial Services
Strong Memorial Hospital
5852753033 | 10/10/2018 9:53 AM |
| Details | Last Recertification Date | Update | Recertification | 11/8/2017 2:26:29 PM | 8/17/2018 9:16:31 AM | 8/17/2018 9:16 AM |
| Addresses | Billing Address | Insert | Recertification | | Highland Hospital
1000 South Avenue
Rochester, NY 14620 | 11/8/2017 2:26 PM |
| Addresses | Shipping Address | Insert | Recertification | | Highland Hospital
1000 South Avenue
Rochester, NY 14620 | 11/8/2017 2:26 PM |
| Details | Last Recertification Date | Update | Recertification | | 11/8/2017 2:26:29 PM | 11/8/2017 2:26 PM |
| Contacts | Authorizing Official | Insert | Change Request | | Segerson, Kevin
Director of Finance
Highland Hospital
5853416686 | 10/13/2017 10:47 AM |
| Contacts | Primary Contact | Update | | Lees, Katy
340B Business Manager
5857855154 | Lees, Katy
340B Business Manager
UR Medicine
5857855154 | 9/22/2017 3:08 PM |
| Contacts | Primary Contact | Insert | | | Lees, Katy
340B Business Manager
5857855154 | 8/30/2017 12:44 PM |
| Addresses | Main Address | Insert | | |
913 CULVER RD
ROCHESTER, NY 14609-7141 | 4/24/2017 4:24 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1740220698 | 3/15/2017 4:36 PM |
| Details | Entity Subname | Update | | CULVER MEDICAL GROUP EXTENSION CLINIC | CULVER MEDICAL GROUP | 3/15/2017 4:36 PM |
| Details | State | Update | | Terminated | Active | 3/15/2017 4:36 PM |
| Terminations | Termination Date | Update | | 1/1/2013 12:00:00 AM | | 3/15/2017 4:36 PM |
| Terminations | Termination Reason | Update | | Other | | 3/15/2017 4:36 PM |
| Dates | Start Date | Update | | 7/1/2011 12:00:00 AM | 4/1/2017 12:00:00 AM | 3/15/2017 4:32 PM |
| Details | Comments Public | Insert | | | 3/15/17 participating 7/1/11 until terminated effective 1/1/13, reinstated effective 4/1/17 | 3/15/2017 4:32 PM |
| Details | State | Update | | Active | Terminated | 12/12/2012 4:18 PM |
| Terminations | Termination Date | Update | | | 1/1/2013 12:00:00 AM | 12/12/2012 4:18 PM |
| Terminations | Termination Reason | Update | | | Other | 12/12/2012 4:18 PM |
| Details | Last Recertification Date | Insert | | | | 6/17/2011 5:31 PM |
| Details | Grant Number | Insert | | | | 6/17/2011 5:31 PM |
| Details | 340B ID | Insert | | | RRC330164-03 | 6/17/2011 5:31 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/17/2011 5:31 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/17/2011 5:31 PM |
| Details | Medicare Provider Number | Insert | | | 330164 | 6/17/2011 5:31 PM |
| Details | Entity Name | Insert | | | HIGHLAND HOSPITAL OF ROCHESTER | 6/17/2011 5:31 PM |
| Details | Program Code | Insert | | | RRC | 6/17/2011 5:31 PM |
| Details | Entity Subname | Insert | | | CULVER MEDICAL GROUP EXTENSION CLINIC | 6/17/2011 5:31 PM |
| Dates | Participating Approval Date | Insert | | | 6/17/2011 12:00:00 AM | 6/17/2011 5:31 PM |
| Details | State | Insert | | | Active | 6/17/2011 5:31 PM |
| Dates | Registration Date | Insert | | | 6/15/2011 12:00:00 AM | 6/17/2011 5:31 PM |
| Dates | Signed By Date | Insert | | | 5/26/2011 12:00:00 AM | 6/17/2011 5:31 PM |
| Dates | Start Date | Insert | | | 7/1/2011 12:00:00 AM | 6/17/2011 5:31 PM |
| Terminations | Termination Comments | Insert | | | | 6/17/2011 5:31 PM |
| Terminations | Termination Date | Insert | | | | 6/17/2011 5:31 PM |
| Terminations | Termination Effective Date | Insert | | | | 6/17/2011 5:31 PM |
| Terminations | Termination Reason | Insert | | | | 6/17/2011 5:31 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 6/15/2011 12:31 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 02998245 | 6/15/2011 12:31 PM |
| Medicaid Billing | Medicaid: State | Insert | | | NY | 6/15/2011 12:31 PM |