Covered Entity Details

DSH330226BZ UNITY HOSPITAL OF ROCHESTER (Terminated) - information as of 5/3/2025 11:33:03 PM

Main Details

Name

UNITY HOSPITAL OF ROCHESTER

Subdivision Name

FRANCIS CENTER (CATHOLIC FAM CTR)

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH330226BZ

Medicare Provider Number

330226

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/11/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/28/2017

Last Recertification Date

9/1/2019

Termination Date
Termination Reason

7/1/2020
Change of covered entity type (non-hospital)

Contacts

Authorizing Official

Rochester Regional Health
Hugh Thomas, Executive Vice President, Chief Administrative Officer
(585) 922-4941

Primary Contact

Unity Hospital
Robert Adams, Assistant Director of Pharmacy
(585) 723-7837

Addresses

Street Address

547 Joseph Ave
Rochester, NY 14605

Billing Address

Unity Hospital
P.O.BOX 10460
Rochester, NY 14610

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
NY	3002917,00378721
		1457395766,1760421713

Shipping Addresses

Shipping Address 1

Park Ridge Hospital, Inc - Genesee Campus Pharmacy
89 Genesee Street
Rochester, NY 14611

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH330226A	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Infectious Disease SM	55 GENESEE ST	ROCHESTER	NY	Active
DSH330226AA	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Andrew J Kirch Dialysis Center at St. Mary's	75 GENESEE ST	ROCHESTER	NY	Active
DSH330226AB	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Healthy Start	89 GENESEE ST	ROCHESTER	NY	Terminated
DSH330226AC	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Family Medicine at Parkway	500 ISLAND COTTAGE RD	ROCHESTER	NY	Active
DSH330226AD	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity OB/GYN at Clinton Crossings	995 SENATOR KEATING BLVD 210	ROCHESTER	NY	Active
DSH330226AE	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Faculty Partners	1561 LONG POND RD STE 206	ROCHESTER	NY	Active
DSH330226AF	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL SYSTEM / Unity Family Medicine at Country Village	1100 LONG POND RD STE 250	ROCHESTER	NY	Active
DSH330226AG	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Adult Day Services at St. Mary's	89 GENESEE ST 2ND FL	ROCHESTER	NY	Terminated
DSH330226AH	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity's Oncology, Hematology/Infusion Center	55 GENESEE ST BK BLDG 1ST FL	ROCHESTER	NY	Active
DSH330226AJ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity St. Mary's Campus Psychiatric Emergency	89 GENESEE ST	ROCHESTER	NY	Terminated
DSH330226AK	Child	DSH	UNITY HOSPITAL OF ROCHESTER	MENTAL HEALTH OUTPATIENT SERVICES / Evelyn Brandon Health Center Mental Health	81 LAKE AVE	ROCHESTER	NY	Active
DSH330226AL	Child	DSH	UNITY HOSPITAL OF ROCHESTER	PARK RIDGE CHEMICAL DEPENDENCY / Evelyn Brandon Health Center Chemical Dependency	81 LAKE AVE	ROCHESTER	NY	Active
DSH330226AM	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Chemical Dependency Greece Clinic	1565 LONG POND RD	ROCHESTER	NY	Active
DSH330226AN	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL SYSTEM / Unity Mental Health Greece Clinic	100 PINEWILD DR STE 2A	ROCHESTER	NY	Active
DSH330226AP	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Internal Medicine at Park Ridge	1561 LONG POND RD	ROCHESTER	NY	Active
DSH330226AQ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	DIALYSIS / Andrew J. Kirch Dialysis Center at Park Ridge	1555 LONG POND RD	ROCHESTER	NY	Terminated
DSH330226AR	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Internal Medicine at Cornerstone	2300 BUFFALO RD BLDG 800C	ROCHESTER	NY	Active
DSH330226AS	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Family Medicine at Chili Center	3379 CHILI AVE 100	ROCHESTER	NY	Active
DSH330226AT	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Infectious Disease SM 3rd FL	89 GENESEE ST BK BLDG 3RD FL	ROCHESTER	NY	Terminated
DSH330226AU	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Brockport / Unity Vascular Surgery Brockport	6668 Fourth Section Road	Brockport	NY	Terminated
DSH330226AV	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UMG PULM MED LIND OAK	10 HAGEN DRIVE	Rochester	NY	Active
DSH330226AW	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Brockport / Unity Pulmonary Medicine Brockport	6668 Fourth Section Road	Brockport	NY	ToBeTerminated
DSH330226AX	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Sleep Disorders Center	1561 Long Pond Road	Rochester	NY	Active
DSH330226AY	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Geriatrics at Brockport / Brockport	6668 Fourth Section Road	Brockport	NY	Terminated
DSH330226AZ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Brockport / Unity Diabetes & Endocrinology Brockport	6668 Fourth Section Road	Brockport	NY	Active
DSH330226B	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Park Ridge / Unity Hematology / Oncology at Park Ridge	1561 LONG POND RD.	Rochester	NY	Active
DSH330226BA	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UMG SLEEP CTR LIND OAK	10 HAGEN DRIVE	Rochester	NY	Active
DSH330226BB	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Ridgeway / Unity Wound Care Center at Ridgeway	2655 Ridgeway Ave. Suite 230	Rochester	NY	Active
DSH330226BC	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Ridgeway / Unity Vascular Surgery Ridgeway	2655 Ridgeway Avenue Suite 240	Rochester	NY	Active
DSH330226BD	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Ridgeway / Unity Neurosurgery Ridgeway	2655 Ridgeway Ave, Suite 460	Rochester	NY	Active
DSH330226BE	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Neurosurgery	2655 Ridgeway Ave., Suite 340	Rochester	NY	Active
DSH330226BF	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Long Pond / Unity Internal Medicine at Long Pond	1561 LONG POND RD	Rochester	NY	Terminated
DSH330226BG	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UNITY PULMONARY MEDICINE / Unity Pulmonary Medicine Park Ridge	1561 LONG POND RD	ROCHESTER	NY	Active
DSH330226BH	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UNITY DIABETES CENTER / Unity Diabetes & Endocrinology Ridgeway	2655 RIDGEWAY AVE	ROCHESTER	NY	Active
DSH330226BJ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UNITY AT RIDGEWAY REHABILITATION / Unity Neurosciences at Ridgeway	2655 RIDGEWAY AVE	ROCHESTER	NY	Active
DSH330226BK	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Geriatrics	105 CANAL LANDING BLVD STE 1	ROCHESTER	NY	Active
DSH330226BL	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity OB/GYN at Park Ridge	1561 LONG POND RD	ROCHESTER	NY	Active
DSH330226BM	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Dental at Penfield	2060 Fairport Nine Mile Pt Rd	Penfield	NY	Terminated
DSH330226BN	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Brockport / Unity Neurosciences	6668 Fourth Section Road	Brockport	NY	Terminated
DSH330226BP	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Assertive Community Treatment / Mental Health Clinic	81 Lake Avenue	Rochester	NY	Active
DSH330226BQ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Infectious Disease Brockport	6668 Fourth Section Road	Brockport	NY	ToBeTerminated
DSH330226BR	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Neurosurgery Elmira	301 E Church Street	Elmira	NY	Terminated
DSH330226BS	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Neurosurgery Corning	56 east First Street	Corning	NY	Terminated
DSH330226BT	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Neurosurgery Batavia	229 Summit St Suite 10	Batavia	NY	Terminated
DSH330226BU	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UNITY HEALTH SYSTEM / HEALTHREACH	89 GENESEE ST	Rochester	NY	Terminated
DSH330226BV	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Health Care for the Homeless / Health Reach Clinic	819 W Main St	Rochester	NY	Terminated
DSH330226BW	Child	DSH	UNITY HOSPITAL OF ROCHESTER	SANCTUARY HOUSE	715 DEWEY AVE	Rochester	NY	Terminated
DSH330226BX	Child	DSH	UNITY HOSPITAL OF ROCHESTER	YWCA	175 CLINTON AVE N	Rochester	NY	Terminated
DSH330226BY	Child	DSH	UNITY HOSPITAL OF ROCHESTER	WOMEN'S PLACE	140 Hobart St	Rochester	NY	Terminated
DSH330226BZ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	FRANCIS CENTER (CATHOLIC FAM CTR)	547 Joseph Ave	Rochester	NY	Terminated
DSH330226C	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Orchard Street / Unity Family Medicine at Orchard Street	158 Orchard Street	Rochester	NY	Terminated
DSH330226CA	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UNITY MOBILE MEDICAL UNIT / UNITY MOBILE MEDICAL UNIT	89 GENESEE ST	Rochester	NY	Terminated
DSH330226CB	Child	DSH	UNITY HOSPITAL OF ROCHESTER	OPEN DOOR MISSION	210 W Main St	Rochester	NY	Terminated
DSH330226CC	Child	DSH	UNITY HOSPITAL OF ROCHESTER	SALVATION ARMY BOOTH HAVEN	70 LIBERTY POLE WAY	Rochester	NY	Terminated
DSH330226CD	Child	DSH	UNITY HOSPITAL OF ROCHESTER	GENESIS HOUSE (SALVATION ARMY)	35 ARDMORE ST	Rochester	NY	Terminated
DSH330226CE	Child	DSH	UNITY HOSPITAL OF ROCHESTER	SALVATION ARMY-HOPE HOUSE	100 WEST AVE	Rochester	NY	Terminated
DSH330226CF	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UH ONCOLOGY AT PARK RIDGE - UH ONCOLOGY AT PARK RIDGE	1555 LONG POND RD	ROCHESTER	NY	Terminated
DSH330226CG	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UHS RIDGEWAY THERAPY (Ortho PT/PT/OT/SLP) - UHS RIDGEWAY THERAPY (Ortho PT/PT/OT/SLP)	2655 RIDGEWAY AVE	ROCHESTER	NY	Terminated
DSH330226CH	Child	DSH	UNITY HOSPITAL OF ROCHESTER	BH UHS HEALTH HOME - BH UHS HEALTH HOME	89 GENESEE ST	ROCHESTER	NY	Terminated
DSH330226CJ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Behavioral Health Unity Health System - Behavorial Health Access and Crisis Center - Behavioral Health Unity Health System - Behavorial Health Access and Crisis Center	89 GENESEE STREET	ROCHESTER	NY	Terminated
DSH330226CK	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UMG THYROID CENTER - UMG THYROID CENTER	1561 LONG POND RD STE 216	ROCHESTER	NY	Terminated
DSH330226CL	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UHS PIETERS Therapy (OT/PT/SLP) - UHS PIETERS Therapy (OT/PT/SLP)	1025 COMMONS WAY	ROCHESTER	NY	Terminated
DSH330226CM	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Pediatrics - Pediatrics at St. Marys	65 Genesee Street	Rochester	NY	Active
DSH330226CN	Child	DSH	UNITY HOSPITAL OF ROCHESTER	OB/GYN - St.Marys OB/GYN	65 Genesee Street	Rochester	NY	Active
DSH330226CP	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UHS ORTHO AT BROCKPORT - Orthopedics	6668 4TH SECTION RD	Brockport	NY	Active
DSH330226CQ	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Medical Group(UMG) Fertility - Fertility	1561 Long Pond Road	Rochester	NY	Active
DSH330226CR	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UHS DENTISTRY ST MARYS - Dentistry	75 Genesee Street	Rochester	NY	Active
DSH330226CS	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UHS DENTISTRY RIDGEWAY - Dentistry	2655 Ridgeway Ave	Rochester	NY	Active
DSH330226CT	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UMG FM AT STM - Family Medicine	55 Genesee Street	ROCHESTER	NY	Active
DSH330226CU	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UMG FM @ ORCHARD ST - Family Medicine	158 ORCHARD ST	ROCHESTER	NY	Active
DSH330226D	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Cornerstone / Unity Adult Day Services at Cornerstone	2300 Buffalo Road, Bldg. 600 A	Rochester	NY	Terminated
DSH330226E	Child	DSH	UNITY HOSPITAL OF ROCHESTER	St. Bernard's / Unity Adult Day Services at St. Bernard's	2260 Lake Avenue	Rochester	NY	Terminated
DSH330226F	Child	DSH	UNITY HOSPITAL OF ROCHESTER	M.S. Achievement Center at Unity	2300 Buffalo Road, Bldg. 600 B	Rochester	NY	Terminated
DSH330226G	Child	DSH	UNITY HOSPITAL OF ROCHESTER	PRH Respiratory	1561 LONG POND RD	Rochester	NY	Terminated
DSH330226H	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Spine Center	2655 Ridgeway Ave., Suite 440	Rochester	NY	Active
DSH330226J	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Orthopaedics at Chili	2115 Chili Avenue	Rochester	NY	Active
DSH330226K	Child	DSH	UNITY HOSPITAL OF ROCHESTER	UMG PFT LAB LIND OAK	10 HAGEN DRIVE	Rochester	NY	Active
DSH330226L	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Comprehensive OP Rehab	2655 RIDGEWAY AVE	Rochester	NY	Active
DSH330226M	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Long Pond / Unity Infectious Disease	1561 LONG POND RD. SUITE 220	Rochester	NY	Active
DSH330226N	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Brockport / Unity Family Medicine at Brockport	6668 Fourth Section Road	Brockport	NY	Active
DSH330226P	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Unity Dialysis at Spencerport	4 Land Re Way	Spencerport	NY	Active
DSH330226Q	Child	DSH	UNITY HOSPITAL OF ROCHESTER	Chili / Unity Dialysis at Chili	3379 Chili Avenue	Rochester	NY	Active
DSH330226R	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity OB/GYN at Parkway	500 ISLAND COTTAGE RD	ROCHESTER	NY	Active
DSH330226S	Child	DSH	UNITY HOSPITAL OF ROCHESTER	RIDGEWAY / Unity Internal Medicine at Ridgeway	120 Erie Canal Drive	ROCHESTER	NY	Active
DSH330226T	Child	DSH	UNITY HOSPITAL OF ROCHESTER	BROCKPORT / Unity OB/GYN at Brockport	6668 4TH SECTION RD	BROCKPORT	NY	Active
DSH330226U	Child	DSH	UNITY HOSPITAL OF ROCHESTER	SPENCERPORT / Unity Family Medicine at Spencerport	4 LAND RE WAY	SPENCERPORT	NY	Active
DSH330226V	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Chemical Dependency Brighton Clinic	2000 WINTON RD S	ROCHESTER	NY	Active
DSH330226W	Child	DSH	UNITY HOSPITAL OF ROCHESTER	RIDGEWAY / Unity OB/GYN at Ridgeway	2655 RIDGEWAY AVE	ROCHESTER	NY	Active
DSH330226X	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Unity Walk-In Care Center	65 GENESEE ST	ROCHESTER	NY	Active
DSH330226Y	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / St. Mary's Radiology	89 GENESEE ST	ROCHESTER	NY	Terminated
DSH330226Z	Child	DSH	UNITY HOSPITAL OF ROCHESTER	THE UNITY HOSPITAL OF ROCHESTER / Blended Case Management	89 GENESEE ST	ROCHESTER	NY	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Thomas, Hugh Executive Vice President, Chief Administrative Officer Unity Hospital 5859224941	Thomas, Hugh Executive Vice President, Chief Administrative Officer Rochester Regional Health 5859224941	7/8/2022 12:36 PM
Contacts	Signed By	Update	Profile Change Request	Thomas, Hugh Executive Vice President, Chief Administrative Officer Unity Hospital 5859224941	Thomas, Hugh Executive Vice President, Chief Administrative Officer Rochester Regional Health 5859224941	7/8/2022 12:36 PM
Details	State	Update		To Be Terminated	Terminated	7/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/22/2020 12:00:00 AM	6/15/2020 7:45 AM
Details	State	Update	Termination Request	Active	To Be Terminated	6/15/2020 7:45 AM
Terminations	Termination Date	Update	Termination Request		7/1/2020 12:00:00 AM	6/15/2020 7:45 AM
Terminations	Termination Effective Date	Update	Termination Request		5/24/2020 12:00:00 AM	6/15/2020 7:45 AM
Terminations	Termination Reason	Update	Termination Request		Change of covered entity type (non-hospital)	6/15/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1760421713	9/1/2019 2:00 PM
Details	Last Recertification Date	Update	Recertification	9/11/2018 4:32:41 PM	9/1/2019 2:00:25 PM	9/1/2019 2:00 PM
Addresses	Shipping Address	Insert	Change Request		Park Ridge Hospital, Inc - Genesee Campus Pharmacy 89 Genesee Street Rochester, NY 14611	10/9/2018 12:30 PM
Addresses	Main Address	Update	Change Request	547 Joseph Ave Rochester, NY 14611	547 Joseph Ave Rochester, NY 14605	10/9/2018 12:30 PM
Details	Last Recertification Date	Update	Recertification	11/5/2017 10:28:06 AM	9/11/2018 4:32:41 PM	9/11/2018 4:32 PM
Details	Last Recertification Date	Update	Recertification		11/5/2017 10:28:06 AM	11/5/2017 10:28 AM
Contacts	Authorizing Official	Update		Thomas, Hugh Executive Vice President, Chief Administrative Officer 5859224941	Thomas, Hugh Executive Vice President, Chief Administrative Officer Unity Hospital 5859224941	10/16/2017 8:49 AM
Contacts	Signed By	Update		Thomas, Hugh Executive Vice President, Chief Administrative Officer 5859224941	Thomas, Hugh Executive Vice President, Chief Administrative Officer Unity Hospital 5859224941	10/16/2017 8:49 AM
Contacts	Primary Contact	Update		Adams, Robert Assistant Director of Pharmacy 5857237837	Adams, Robert Assistant Director of Pharmacy Unity Hospital 5857237837	10/10/2017 2:02 PM
Addresses	Main Address	Insert			547 Joseph Ave Rochester, NY 14611	4/28/2017 3:53 PM
Addresses	Billing Address	Insert			Unity Hospital P.O.BOX 10460 Rochester, NY 14610	4/28/2017 3:53 PM
Contacts	Authorizing Official	Insert			Thomas, Hugh Executive Vice President, Chief Administrative Officer 5859224941	4/28/2017 3:53 PM
Contacts	Signed By	Insert			Thomas, Hugh Executive Vice President, Chief Administrative Officer 5859224941	4/28/2017 3:53 PM
Contacts	Primary Contact	Insert			Adams, Robert Assistant Director of Pharmacy 5857237837	4/28/2017 3:53 PM
Dates	Participating Approval Date	Update			4/28/2017 12:00:00 AM	4/28/2017 3:47 PM
Details	State	Update		Pending	Active	4/28/2017 3:47 PM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/28/2017 3:47 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_76457	DSH330226BZ	4/26/2017 11:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/11/2017 10:08 AM
Medicaid Billing	Medicaid: Number	Insert			3002917	4/11/2017 10:08 AM
Medicaid Billing	Medicaid: State	Insert			NY	4/11/2017 10:08 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/11/2017 10:08 AM
Medicaid Billing	Medicaid: Number	Insert			00378721	4/11/2017 10:08 AM
Medicaid Billing	Medicaid: State	Insert			NY	4/11/2017 10:08 AM
Medicaid Billing	NPI: Number	Insert			1457395766	4/11/2017 10:08 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_76457	4/11/2017 10:08 AM
Details	Last Recertification Date	Insert				4/11/2017 10:08 AM
Details	Grant Number	Insert				4/11/2017 10:08 AM
Details	340B ID	Insert				4/11/2017 10:08 AM
Details	Is Authorizing Official EHB Data	Insert				4/11/2017 10:08 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/11/2017 10:08 AM
Details	Medicare Provider Number	Insert			330226	4/11/2017 10:08 AM
Details	Entity Name	Insert			UNITY HOSPITAL OF ROCHESTER	4/11/2017 10:08 AM
Details	Program Code	Insert			DSH	4/11/2017 10:08 AM
Details	Entity Subname	Insert			FRANCIS CENTER (CATHOLIC FAM CTR)	4/11/2017 10:08 AM
Dates	Participating Approval Date	Insert				4/11/2017 10:08 AM
Details	State	Insert			Pending	4/11/2017 10:08 AM
Dates	Registration Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 10:08 AM
Dates	Signed By Date	Insert			4/11/2017 12:00:00 AM	4/11/2017 10:08 AM
Dates	Start Date	Insert				4/11/2017 10:08 AM
Terminations	Termination Comments	Insert				4/11/2017 10:08 AM
Terminations	Termination Date	Insert				4/11/2017 10:08 AM
Terminations	Termination Effective Date	Insert				4/11/2017 10:08 AM
Terminations	Termination Reason	Insert				4/11/2017 10:08 AM